Pretibial Edema Strain Ratio Obtained by Elastography Can Be Used in Differential Diagnosis of Patients with Chronic Heart Failure and Nephrotic Syndrome

Objective: Pretibial edema is a common examination finding in patients with both heart failure and nephrotic syndrome. We aimed to evaluate the utility of pretibial edema strain ratio obtained by strain elastography in the diagnosis of heart failure and nephrotic syndrome. Materials and Methods: A total of 80 patients (40 patients with heart failure and 40 patients with nephrotic syndrome) were included in this study. Physical examination echocardiography and laboratory examinations were performed. Pretibial edema elastographic color grade and pretibial edema strain ratio measurements were performed in the pretibial edema region by strain elastography. Results: Pretibial edema strain ratio and presence of pretibial edema elastographic color grade-I were found to be higher in heart failure. Tricuspid regurgitation pressure gradient, left ventricular diameters and volumes were significantly higher and left ventricular ejection fraction was significantly lower in heart failure. Left ventricular ejection fraction and pretibial edema strain ratio independently determined the presence of heart failure. The each-0.1 increase in pretibial edema strain ratio was being to the risk of heart failure by 29.1%. In predicting presence of heart failure, the area under the ROC curve was 0.827 for pretibial edema strain ratio. The cut-off value for pretibial edema strain ratio was taken as 0.70, it was determined the patients with heart failure disease with 80.0% sensitivity and 76.5% specificity. Pretibial edema strain ratio value was found to be closely related to tricuspid regurgitation pressure gradient, left ventricular ejection fraction and left ventricular volumes. The close relationship was found between pretibial edema strain ratio and tricuspid regurgitation pressure gradient. Conclusion: In patients with heart failure, the pretibial edema strain ratio obtained by strain elastography is higher than in patients with nephrotic syndrome and can be used as an objective parameter for heart failure differential diagnosis in addition to conventional heart failure diagnostic methods.