Background:

Pericardial effusion in ARF has been described in 5-10% of patients but contemporary data is sparse. The ARC diagnostic network is a multi-site collaborative effort to identify diagnostic biomarkers for ARF. This collaborative presents a unique opportunity to assess the incidence and the relationships between ARF, RHD and pericardial effusion.

Methods:
Cases were recruited from 4 sites (Pakistan, Brazil, Malawi, Timor-Leste). Echocardiograms were transferred to a cloud server (Trice) and underwent adjudication by a panel of global experts. Presence and severity of pericardial effusion was assessed. Clinical outcomes including hospitalization and death were recorded. Descriptive statistics were used for the analysis.

Results:
A total of 203 children with ARF and 180 with RHD form the study group. Of these 39 (10.2%) had a pericardial effusion; 23 (11%) of ARF and 16 (9%) of RHD. The median age was 12(10-13.5) years and 21 (54%) were females. The cases distributed were: Pakistan (21/206, 11%), Malawi (14/93, 15%), Brazil (1/44, 2%), and Timor-Leste (3/40, 7.5%). It was mild in 35 (90%) and moderate to large in 4 (10%) cases. All children with pericardial effusion were associated with moderate to severe valve disease (39/39, 100%), when compared with children with no pericardial effusion and moderate to severe disease (227/344, 66%), p<0.001. Hospitalization was required in 26 (67%) patients and there were 2 (5%) deaths.

Conclusions:

Pericardial effusion may be a manifestation of severe valvar heart disease and not a purely inflammatory component of ARF. Follow-up studies are needed to see the long-term outcome.