Background:
The Children’s Hospital of Lahore in Punjab, Pakistan, manages many Acute Rheumatic Fever (ARF) cases through its cardiology service. Pericardial effusion (PCE) is a recognized feature of ARF and may be associated with poorer clinical outcomes. This study, leveraging data from the ARC Network, aimed to assess the global incidence of PCE in ARF and its relationship with adverse outcomes.
Methods:
A total of 136 confirmed ARF cases were reviewed, explicitly focusing on the presence and severity of PCE. Clinical outcomes, including hospitalization and mortality, were also evaluated.
Results:
There were 14 cases of PCE in this cohort (10%). Children with a PCE had a median age of 11 years (IQR: 9–13), 57% of patients being female, and distributed across four countries: Pakistan (n=10), Malawi (n=2), Brazil (n=1), and Timor-Leste (n=1). Slightly more than half of cases (8/14, 57%) were first episodes diagnosed, but all had concerns for prior unrecognized rheumatic heart disease (RHD). Most children had significant concurrent valvular heart disease, with severe mitral regurgitation in 7 cases (50%), moderate-to-severe mitral regurgitation in 5 (36%), and mitral stenosis in 5 cases (36%). All PCEs were small (n=13), but one with a moderate-to-large PCE was also the sole fatality in the cohort.
Conclusions:
PCE was associated with severe valvular disease in this cohort, but its role as an independent predictor of adverse outcomes remains unclear due to limited events. The sole fatality involved moderate-to-large PCE. Further research is needed to elucidate the prognostic significance of PCE in ARF.