The Pretibial edema strain ratio obtained by elastography can be used in differential diagnosis of patients with chronic heart failure and nephrotic syndrome

Abstract

Objective: Pretibial edema (PTO) is a common examination finding in patients with both heart failure (HF) and nephrotic syndrome (NS).  We aimed to evaluate the utility of PTO strain ratio (PTO-SR) obtained by strain elastography (SE) in the diagnosis of HF and NS.

Materials and Methods: A total of 80 patients (40 patients with HF and 40 patients with NS) were included in this study. Physical examination echocardiography and laboratory examinations were performed. PTO elastographic color grade and PTO-SR measurements were performed in the PTO region by SE.

Results: PTO-SR and presence of PTO elastographic color grade-I were found to be higher in HF. Tricuspid regurgitation pressure gradient (TRPG), left ventricular (LV) diameters and volumes were significantly higher and LV ejection fraction (EF) was significantly lower in HF. LVEF and PTO-SR independently determined the presence of HF. The each-0.1 increase in PTO-SR was being to the risk of HF by 29.1%. In predicting the presence of HF, the area under the ROC curve was 0.827 for PTO-SR. The cut-off value for PTO-SR was taken as 0.70, it was determined the patients with HF disease with 80.0% sensitivity and 76.5% specificity. PTO-SR value was found to be closely related to TRPG, LVEF, and LV volumes. A close relationship was found between PTO-SR and TRPG.

Conclusion: In patients with HF, the PTO-SR obtained by SE is higher than in patients with NS and can be used as an objective parameter for HF differential diagnosis in addition to conventional HF diagnostic methods.