Global right and left ventricular function and structure in children with acute poststreptococcal glomerulonephritis

Abstract EN

Background and Aim of work: Cardiac involvement is one of the features of acute poststreptococcal glomerulonephritis (APGN).Echocardiography is recommended because there may be subtle changes indicating early cardiac involvement without frank signs of heart failure.

The aim of this study was to assess cardiac structural and functional changes (right and left) in children suffering from APGN during the acute phase of the disease.

Study populations: 25 cases of APGN patients compared with 25 control healthy children.

Full investigations were done including M mode and 2 D echocardiography for all cases.

Isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET), and the combined index of myocardial performance (Total isovolumic ejection time index = IRT + ICT/ET), were calculated by echocardiography Doppler for both the right and left ventricle.

Results: This study showed that there were statistically higher values of left ventricular parameters as left ventricular end diastolic diameter (LVEDD), left ventricular mass (LVM) with a normal left ventricular ejection fraction (LVEF), and left ventricular fractional shortening (LVFS) in both groups with a statistical significant difference.

Regarding the diastolic function by E/A ratio, there was non significant difference between patients with APGN and controls (p<0.3).

There was also statistically higher value of right ventricular end diastolic diameter (RVEDD) in cases when compared to control children.

There was a statistically significant difference between cases and controls for both the right and left global myocardial function estimated by Tei Index.

However the combined myocardial performance unmasked presence of both left and right ventricular dysfunction.

There were 4 patients with pericardial effusion in study children, although there was no case with severe hypertension or renal impairment during the acute phase of illness.

Conclusion: The study concluded that, there is cardiac involvement, in the acute phase of APGN without frank signs of heart failure and without evidence of associated severe hypertension or renal failure.

This may pay the attention to the importance of performing of echocardiography early in the disease and follow up after the acute phase.

Total isovolumic ejection time index could be a sensitive index for detecting early changes in both right and left ventriclular combined performance in acute poststreptococcal glomerulonephritis (APGN) patients.

This new echocardiographic technique can be incorporated into a conventional transthoracic study