Assessment of Left Atrial Strain and Diastolic Function Parameters in Adult Primary Nephrotic Syndrome Patients

PURPOSE: Although cardiovascular disease commonly accompanies chronic kidney disease, the extent of cardiac involvement in primary nephrotic syndrome (PNS) remains insufficiently defined. The objective of this research was to investigate left atrial reservoir strain (LASr) and diastolic function in adult patients with histopathologically confirmed PNS. METHODS: A total of 75 adults with histologically confirmed PNS and 100 controls were enrolled in this study. Transthoracic echocardiography was performed on all patients, encompassing conventional Doppler, tissue Doppler imaging, and LASr assessment through speckle-tracking analysis. The assessment of diastolic function was performed through measurements of the E/A ratio and the E/e' ratio. Associations between PNS and LASr were analyzed with multivariable linear regression. RESULTS: LASr was significantly lower in PNS patients than in controls (37.7% ± 6.7% vs. 45.4% ± 7.9%, p < 0.001). The PNS group also showed a mild but statistically significant difference in E/e' (7.3 ± 1.7 vs. 6.7 ± 1.3, p = 0.013) and a lower E/A ratio (1.0 ± 0.3 vs. 1.2 ± 0.3, p < 0.001). Multivariable analysis confirmed that PNS was independently associated with lower LASr (β = -4.582, 95% CI: -6.86 to -2.30, p < 0.001). CONCLUSION: Adult patients with PNS demonstrate lower LASr and mild alterations in conventional diastolic indices. These findings are consistent with early subclinical cardiac remodeling and support LASr as a sensitive adjunctive marker in cardiovascular risk assessment.