Cardiac and aortic lesions in nephrotic syndrome

THE AIM: To study heart and aortic involvement in patients with nephrotic syndrome (NS) depending on sex. 

PATIENTS AND METHODS. A retrospective analysis included 170 patients (mean age 32.1±12.0 years) with verified NS based on clinical and laboratory findings. All participants were divided into two subgroups: men (n=105) and women (n=65). Laboratory parameters, general clinical data, electrocardiographic (ECG), and echocardiographic parameters were assessed. 

RESULTS . In men with NS, the mean levels of diastolic and mean arterial pressure, platelet count, total cholesterol (TC), and creatinine were significantly higher, while total protein concentration was significantly lower compared to women. Women with NS had a statistically significantly higher heart rate, while hemoglobin (Hb), hematocrit, erythrocyte count, and mean corpuscular hemoglobin levels were significantly lower. Among all patients with NS, ECG signs of myocardial excitability and conduction disturbances were detected in 17.6 % and 4.1 % of cases, respectively. Left ventricular (LV) repolarization abnormalities were observed in 20 patients (11.7 %). Pathological ECG changes were found in 29 (27.6 %) men and 28 (43.0 %) women. Men had significantly larger linear dimensions of the LV, right ventricle, and aortic outflow tract compared to women. LV myocardial hypertrophy was detected in 17 (10 %) patients, while concentric LV remodeling was observed in 5 (2.9 %) cases. LV myocardial hypertrophy was more common in women. In men with NS, the LV myocardial mass index was significantly correlated with daily proteinuria (r=0.378; p=0.036), TC level (r=0.222; p=0.041), and fibrinogen concentration (r=0.306; p=0.021), while it was inversely correlated with albumin concentration (r=0.371; p=0.039). In women, the LV myocardial mass index showed a positive correlation with daily proteinuria (r=0.265; p=0.016) and fibrinogen concentration (r=0.230; p=0.019). 

CONCLUSION. Patients with NS frequently exhibit ECG signs of myocardial excitability and LV repolarization disturbances. Cardiac involvement in NS is primarily represented by concentric LV remodeling in men and eccentric LV myocardial hypertrophy in women. Regardless of sex, LV myocardial mass is strongly associated with daily proteinuria and fibrinogen concentration, while the diameter of the aortic outflow tract is linked to diastolic blood pressure levels.

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