Evaluating cardiovascular involvement by echocardiography in patients with antineutrophil cytoplasmic antibodies associated glomerulonephritis

Objective: Cardiovascular involvement in patients with antineutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis (AGN) could be asymptomatic but is closely associated with patients’ prognosis. The aim of this study was to evaluate the cardiovascular involvement using standard echocardiographic measurements and determine echocardiographic predictors for cardiovascular mortality in those patients. Methods: Patients with newly diagnosed AGN from Department of Nephrology, Ruijin Hospital undergoing transthoracic echocardiography were retrospectively studied. Cox proportional hazards models were used to investigate baseline variables associated with cardiovascular mortalities. Results: Of 319 patients enrolled in our study, 221 patients had echocardiographic abnormalities. Valvular abnormalities were the most common presentation of cardiovascular involvement and valvular regurgitation was the most commonly presentation of echocardiographic abnormality. Patients with echocardiographic abnormalities had more severe renal involvement. And patients with more advanced age and more severe renal involvement had worse cardiovascular outcome. Kaplan-Meier estimator showed a 3.4-time higher risk of cardiovascular mortality in patients with echocardiographic abnormalities than those without (p<0.01). Left ventricular end diastolic volume (LVEDV, HR=1.63, p<0.001), left ventricular end systolic volume (LVESV, HR=1.47, p<0.001) and left ventricular ejection fraction (LVEF, HR=0.72, p<0.05), are independent predictors of cardiovascular mortality. Conclusions: Cardiac involvement was prevalent in patients with AGN. LVEDV, LVESV and LVEF assessed by echocardiography at disease onset are independent prognostic factors for cardiovascular mortality in AGN patients. Our results suggest that echocardiography is a sensitive and non-invasive tool to evaluate cardiovascular abnormalities in AGN patients which could be applied to detect those abnormalities in early stages.