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This paper aims to perform global assessment of long-term cardiac function in juvenile idiopathic arthritis (JIA) patients under TNF blockage therapy.Twenty-five polyarticular-course JIA patients pre-anti-TNF and 22 healthy controls underwent conventional/tissue Doppler echocardiography and cardiac biomarkers measurements (N-terminal pro-brain natriuretic peptide [NT-pro-BNP] and troponin T) at baseline (BL). Twenty-one JIA patients completed six evaluations during two consecutive years. Clinical/laboratorial evaluations were assessed before and during TNF blockage therapy.JIA patients and controls were comparable regarding current age (p=0.898) and female gender (p=0.38). At BL isovolumetric relaxation time of left ventricle (p=0.03), ventricular septum (VS), E' wave (p=0.014) and VS S wave velocity (p=0.03) were significantly reduced in JIA patients compared to controls. Frequencies of elevated NT-pro-BNP and troponin T levels were similar in JIA and controls (p=0.297 and p=0.756) and levels remained within normal range throughout the study, except for one patient with mild troponin T elevation. During TNF blockage therapy, none of the 21 participants had heart failure, ejection fraction or other parameters alterations in conventional and tissue Doppler. Only one had mild pulmonary hypertension. Further analysis revealed that JIA patients with elevated levels of NT-pro-BNP at BL had significantly more active joints (p=0.025) and higher ESR (p=0.034).Long-term TNF blockage safety was demonstrated in JIA patients in spite of the observed subclinical diastolic involvement. Elevated cardiac biomarker in these patients was associated with inflammatory parameters reinforcing the need for a careful interpretation of this finding in patients with active disease.

The defects of the ventricular septum have received special attention from investigators working in echocardiography. The method showed an incomparable capability to identify all the morphological features of the defects. The increasing improvement in definition of transducers associated with conventional and color Doppler contributed significantly to the reliability to detect most of the defects. The great majority of associated lesions can be easily identified and serial examinations allow prediction of which defect may become smaller or even close spontaneously as well as which have acquired deleterious changes in the heart. Several authors have shown very good statistical correlations between echocardiographic indices and hemodynamic parameters in patients with this type of defect. Doppler echocardiography has become an invaluable tool in the diagnosis and follow-up of ventricular septal defect reducing the need for cardiac catheterization and helping management of these patients. (ECHOCARDIOGRAPHY, Volume 8, July 1991)

Peripartum cardiomyopathy is a rare disease of unknown etiology. Risk factors for its development include increased maternal age, black race, multiparity, twinning, malnutrition, toxemia and hypertension. 1,2 The mortality rates in the acute and subacute phases range from 30 to 60%. 3 The prognosis is especially poor in patients with significant cardiomegaly persisting >6 months and in patients with low left ventricular (LV) ejection fraction. 4,5 Other noninvasive or clinical characteristics affecting severity and prognosis of the disease have not been well defined. We describe our experience with 19 consecutive patients with peripartum cardiomyopathy who were prospectively evaluated in Sao Paolo, Brazil.

Endomyocardial fibrosis (EMF) is a disease of unknown etiology characterized by progressive fibrosis and obliteration of the right ventricular (RV) or left ventricular (LV) cavities and often associated with atrioventricular valve incompetence. Patients with EMF have a poor prognosis. Surgical treatment usually results in clinical and hemodynamic improvement. 1–6 In this study we present pre- and postoperative clinical and noninvasive follow-up in 15 consecutive patients with EMF.