The low cTnT values, especially in the presence of active carditis, dispute significant ischemic myocyte injury.[16] Myocardial necrosis is not prominent despite intensive inflammation in ARF.[17] ARF is mainly a disease of connective tissue, and endocarditis is the prominent factor.[18] This may explain the normal concentrations of cTnT found in patients with ARF carditis. This evidence concerns the gene TNNT2 and rheumatic fever.