Evaluating the myocardial functions of the forgotten right ventricle in children with nephrotic syndrome utilizing traditional echocardiography, two-dimensional speckle tracking and three-dimensional echocardiography

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BACKGROUND: Primary nephrotic syndrome (NS) is associated with systemic effects that may impact cardiac function, although several studies have explored left ventricle in children with NS. Few studies investigated right ventricle (RV) in this disease. Therefore, the study aimed to provide a comprehensive evaluation of RV functions in children with primary NS using echocardiography. METHODS: A case-control observational study was conducted from January 2022 to August 2024 on 40 primary NS patients with steroid-resistant nephrotic syndrome (SRNS) and steroid-sensitive nephrotic syndrome (SSNS), alongside 40 healthy controls. All participants underwent RV assessments using conventional parameters, tissue Doppler imaging (TDI), two-dimensional speckle-tracking echocardiography (2D STE), and three-dimensional echocardiography (3DE). RESULTS: Significantly lower s', e' in NS patients compared to controls, especially lower in SRNS compared to SSNS. Significantly higher E/e' and Tei index was detected in the NS group compared to controls (p = < 0.001) and more pronounced in SRNS. RV free wall strain longitudinal strain (RVFWLS) and RV four chamber longitudinal strain (RV4CSL) were significantly reduced in NS group compared to controls. 3D auto RV-derived ejection fraction (EF), TAPSE, stroke volume and septal strain were lower in NS compared to controls(p = < 0.001); however, there are no significant differences between SSNS and SRNS. Significant correlations were detected between some echocardiographic parameters and serum cholesterol, albumin, and creatinine. CONCLUSIONS: Integrative use of variable echocardiographic modalities allows detection of subclinical alterations in RV function in children with primary NS, with more affected parameters in SRNS. Therefore, regular surveillance of RV functions in primary NS should be considered.

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