Oflaz Huseyin, Sen Fatma, Bayrakli Sengul Kavak, Elitok Ali, Cimen Arif Oguzhan, Golcuk Ebru, Kasikcioglu Erdem, Tukenmez Mustafa, Yazici Halil, Turkmen Aydin
Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. huseyinoflaz@ yahoo.com
Ren Fail. 2008;30(9):914-20. doi: 10.1080/08860220802353819.
Increased cardiovascular disease risk is very well known in nephrotic syndrome. Coronary flow reserve measurement by trans-thoracic echocardiography reflects coronary microvascular and endothelial function. However, diastolic filling abnormalities by echocardiography may indicate diastolic dysfunction. Our aim was to evaluate endothelial and diastolic functions by trans-thoracic echocardiography in nephrotic syndrome.
Eighteen patients with nephrotic syndrome (five females, 34 +/- 17 years) and 30 controls (10 females, 35 +/- 10 years) were evaluated in this cross-sectional observational study. Age, weight, lipid profile, glucose, blood urea nitrogen, creatinine, serum albumin, total protein, C-reactive protein, erythrocyte sedimentation rate, blood pressures, 24-hour urine volume, and protein were recorded. Glomerular filtration rate was estimated by Cockcroft-Gault Formula. Doppler flow and other echocardiographic parameters were measured by Vivid 7 echocardiography.
Coronary flow reserve was significantly lower in patients than controls (p < 0.001) and was negatively correlated with proteinuria (p < 0. 001), creatinine levels (p = 0.03), total cholesterol (p = 0.02), C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.005). E/A ratio was significantly lower in patients than in controls (p = 0.005). DT was significantly higher in patients than in controls (p = 0.01) and isovolumic relaxation time was similar in both groups.
Coronary flow reserve and left ventricular diastolic filling are significantly impaired in nephrotic syndrome. Proteinuria, serum creatinine, total cholesterol and inflammation may have all contributory effects on endothelial dysfunction. Early evaluation of patients with nephrotic syndrome should include coronary flow and diastolic function by echocardiography.
肾病综合征患者心血管疾病风险增加已广为人知。经胸超声心动图测量冠状动脉血流储备反映冠状动脉微血管和内皮功能。然而，超声心动图显示的舒张期充盈异常可能提示舒张功能障碍。我们的目的是通过经胸超声心动图评估肾病综合征患者的内皮功能和舒张功能。
在这项横断面观察性研究中，对18例肾病综合征患者（5例女性，年龄34±17岁）和30例对照者（10例女性，年龄35±10岁）进行了评估。记录年龄、体重、血脂谱、血糖、血尿素氮、肌酐、血清白蛋白、总蛋白、C反应蛋白、红细胞沉降率、血压、24小时尿量和蛋白质。采用Cockcroft-Gault公式估算肾小球滤过率。使用Vivid 7超声心动图测量多普勒血流及其他超声心动图参数。
患者的冠状动脉血流储备显著低于对照组（p<0.001），且与蛋白尿（p<0.001）、肌酐水平（p = 0.03）、总胆固醇（p = 0.02）、C反应蛋白（p = 0.02）和红细胞沉降率（p = 0.005）呈负相关。患者的E/A比值显著低于对照组（p = 0.005）。患者的DT显著高于对照组（p = 0.01），两组的等容舒张时间相似。
肾病综合征患者的冠状动脉血流储备和左心室舒张期充盈明显受损。蛋白尿、血清肌酐、总胆固醇和炎症可能均对内皮功能障碍有促成作用。肾病综合征患者的早期评估应包括通过超声心动图评估冠状动脉血流和舒张功能。
