Evaluation of left ventricular global longitudinal strain in patients with adult primary nephrotic syndrome

Objective: Nephrotic syndrome is a clinical condition accompanied by severe proteinuria, hypoalbuminemia and edema. Studies have shown that patients with nephrotic syndrome have an increased risk of cardiovascular events such as heart failure, acute coronary syndrome, and death. The left ventricular Global Longitudinal Strain (LVGLS) is an indicator of left ventricular systolic function and can detect subclinical deterioration in systolic function early, even when there is no deterioration in left ventricular ejection fraction (LVEF). There is no study evaluating LVGLS in adult patients with primary nephrotic syndrome(PNS). In this study, we aimed to evaluate LVGLS in PNS patients. Methods: For this prospective single-center study, patients with nephrotic syndrome who were followed up in the nephrology department of Dicle University Faculty of Medicine between 1 May and 31 July 2022 and whose diagnosis of PNS was confirmed by biopsy were evaluated. Patients with similar age and gender characteristics without nephrotic syndrome were included as the control group. Conventional echocardiographic parameters and global longitudinal strain measurements were performed. Results: A total of 171 patients, 57 with PNS and 114 in the control group, were included in the study. The mean age was 38±12 years in the study population, and 95 (56%) of the patients were women. The patients were divided into two groups as PNS group and control group. LVEF % was 60.2±4.2 in the PNS group and 61.1±3.2 in the control group, and there was no significant difference between the two groups (p=0.074). LVGLS was found to be significantly lower in the PNS group (-19.3±2.3) than in the control group (-20.8±1.5) (p<0.001). A significant relationship was observed between PNS and LVGLS in the multivariable linear regression analysis (β= 4.428, Confidence Interval 95% =0.57–1.48, p<0.001). Conclusion: A significant relationship was observed between PNS and SVGLS in multivariate linear regression analysis, and LVGLS was found to be lower in PNS patients. In these patient groups, patients with subclinic left ventricular systolic dysfunction can be detected in the early period by measuring LVGLS.