Non-Invasive Imaging for Evaluating Cardiovascular Involvement in Patients with Primary and Lupus Nephritis
Marco Atteritano1, *, Luca Visconti1, Giuseppe Dattilo1, Carmelo Zuppardo1, Antonio Lacquaniti1, Vito Maurizio Parato2, Alessandro Migliorato1, Giovanni Conti3, Domenico Santoro1
1 Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
2 Department of Emergency, Section of Cardiology, Hospital “Madonna del Soccorso”, San Benedetto del Tronto, Italy
3 Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
Evidence suggests that proteinuric diseases, such as primary or secondary glomerulonephritis, increase cardiovascular risk, but few studies confirmed this association.
This is a cross-sectional, observational study on 32 patients, 17 with Primary Glomerulonephritis (PG) and 15 with Lupus Glomerulonephritis (LG). The control group consisted of 32 healthy individuals. Intima-media thickness (IMT) of the left common carotid artery, carotid bifurcation and internal carotid artery was measured by ultrasound. Left ventricular myocardial deformation was assessed by the use of the Global Circumferential Strain (GCS) and the Global Longitudinal Strain (GLS) following 2-Dimensional (2D) echocardiography in all participants.
Patients with glomerulonephritis in both groups showed significantly lower GLS compared with controls (p=0.0005). There was also a significant difference in common carotid IMT values between the LG and GP group (0.45±0.09 vs. 0.58±0.17 mm, respectively; p=0.01), but there was no difference with the control group. In patient group (n=32), a significantly positive correlation was observed between C-reactive protein and proteinuria (r=0.98; p<0.0001), whereas negative correlations were found between common carotid IMT and creatinine clearance (r=-0.97; p<0.0001) and between carotid bifurcation IMT and phosphate levels (r=-0.97; p<0.0001)
Subclinical systolic myocardial dysfunction is present early in the course of glomerular disease. The use of 2D GLS revealed that LG and PG patients with no cardiovascular symptoms or history and a preserved left ventricle ejection fraction on conventional echocardiography had subclinical reduction in LV global longitudinal systolic function compared with controls.
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* Address correspondence to this author at the Department of Clinical and Experimental Medicine, University of Messina, AOU “Policlinico G. Martino” Via Consolare Valeria n.1, 98125 Messina, Italy; Tel: +393396753553;