Biomarkers and echocardiography for evaluating the improvement of the ventricular diastolic function after surgical relief of hydronephrosis

Abstract

The pathophysiology of cardio-renal syndrome (CRS) is complex. Hydronephrosis caused by urolithiasis may cause cytokine release and lead to cardiac dysfunction. The aim of this study was to evaluate cardiac function changes observed in patients who received double J placement using feasible biomarkers and echocardiography. This was a prospective, single-center study. Eighty-seven patients who presented with acute unilateral hydronephrosis and received ureteroscope stone manipulation were enrolled. Echocardiography and cytokines were measured on the day of the operation and 24 hours after the procedure. Changes before and after surgery were assessed by the paired t-test and Wilcoxon test. Correlation analyses between echocardiographic diastolic indices and cytokine levels were performed using Pearson's correlation coefficients. Patients with hydronephrosis showed a higher left atrium volume index (LAVI), decreased E', and increased E/ E' ratio, which indicated diastolic dysfunction. Patients with hydronephrosis also exhibited decreased global strain rates during isovolumetric relaxation (SRIVR) and E/ SRIVR, which confirmed the diastolic dysfunction. Significant reductions in LAVI, increases in SRIVR and decreases in E/ SRIVR were observed after the operation. Biomarkers, such as TGF-β and serum NT-proBNP, were significantly decreased after surgery. In addition, a significant correlation was observed between the post-surgical decrease in TGF-β1 and increase in SRIVR. Unilateral hydronephrosis causes cardiac diastolic dysfunction, and relieving hydronephrosis could improve diastolic function. Improvements in cardiac dysfunction can be evaluated by echocardiography and measuring cytokine levels. The results of this study will inform efforts to improve the early diagnosis of CRS and prevent further deterioration of cardiac function when treating patients with hydronephrosis.

Fig 1. Speckle tracking, strain, and strain rate.

Averaged global strain rate signal (in brown) using 2D speckle tracking. Notice the strain rate (SR) during the isovolemic relaxation time (*), early diastole phase, and late diastole phase. AVC, aortic valve closure; MVO, mitral valve opening; SR_IVR, global SR during the isovolumetric relaxation period; SR_E, global SR during early LV filling; SR_L, global SR during late LV filling.

Fig 2. Relationship between TGF-beta levels and strain rate indices.

Relationship between TGF-beta levels and strain rate indices. The post-operational changes in TGF-beta levels correlated with the post-operational changes in global strain rate during the isovolumetric relaxation period (SR_IVR), which is a sensitive marker of cardiac diastolic function. r, correlation coefficient; P, significance level.