Role of serum cardiac troponin T in the diagnosis of acute rheumatic fever and rheumatic carditis

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Abstract
Forty six consecutive patients (29 males) with ARF diagnosed (according to the modified Jones’ criteria) within two years, were prospectively studied. A new murmur of aortic or mitral regurgitation was considered as clinical evidence of carditis. This was confirmed by echocardiography at the time of the diagnosis. We used the previously established Doppler echocardiographic guidelines to define pathological mitral and aortic insufficiency.2 We also measured left ventricular systolic and diastolic diameters and fractional shortening in parasternal long axis position with M mode echocardiography. Serum cTnT concentrations were determined by using the third generation Elecsys Troponin T STAT immunoassay (Roche Diagnostics Mannheim, Germany), standardised with human recombinant cTnT. The lower detection limit of the assay is 0.01 ng/ml and the normal range for cTnT is 0.01 to 0.1 ng/ml. Serum creatine kinase isoenzyme MB (CK-MB) activity level was measured by routine laboratory assays, which have an upper reference limit of 5 ng/ml. Troponin T and CK-MB assessments are not standard components of the evaluation of suspected ARF at our institution. Data are compared between groups using independent sample t test. Probability values of p < 0.05 were considered significant.