Nocturia is the most common and bothersome lower urinary tract symptoms (LUTS). Except for urological disorders, nocturia is also caused by systemic diseases. Heart failure and uncontrolled hypertension lead to clinically significant nocturia. Cardiac diseases with left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) identified by electrocardiographic (ECG) had association with nocturia. We aim to investigate the relationship between nocturia and cardiac structural abnormalities on cardiac sonography.

We included the adult patients in cardiology outpatient department whom received the cardiac sonography from June 1, 2021 to July 31, 2021. All the patients were asked of the times of nocturia in the past six months before the echocardiographic examination. Univariate and multivariate analyses were done with logistic regression to evaluate the predictive value of nocturia on echocardiographic abnormalities. Statistical analysis was performed by Pearson’s chi square test and p value of < 0.05 was considered to be statistically significant.

A total of 299 patients were included, and up to 267 (89.3%) patients reported to have nocturia. Besides, 109 patients met the criteria of LAE (36.5%) and 85 patients had LVH (28.4%). In all patient, age older than 65 years (2.0 +/- 1.1 versus 1.4 +/- 1.0, p = 0.0001), diabetes mellitus (2.0 +/- 1.1 versus 1.7 +/- 1.1, p = 0.027), LAE (2.1 +/- 1.1 versus 1.7 +/- 1.1, p = 0.001), LVH (2.1 +/- 1.2 versus 1.7 +/- 1.1, p = 0.014), and moderate AR (2.1 +/- 1.2 versus 1.8 +/- 1,1, p = 0.048) were associated with higher times of nocturia. In patients older than 65 years of age, LAE (2.3 +/- 1.1 ver sus 1.9 +/- 1.1, p = 0.008) and LVH (2.3 +/- 1.1 versus 2 +/- 1.1, p =0.012) had higher times of nocturia. On multivariate analysis, the presence of nocturia could be predictive factor of LAE (odds ratio 1.347, 95% CI 1.062 – 1.710, p = 0.014). In subgroup of patients older than 65 years of age, nocturia was not only predictive of LAE (odds ratio 1.362, 95% CI 1.034 – 1.793, p=0.028), but also LVH (odds ratio 1.397, 95% CI 1.057 – 1.846, p=0.019).

In the present study, we found that old age, diabetes, and echocardiographic evidence of LAE and LVH were significantly associated with higher times of nocturia. Moreover, nocturia could be predictive of LAE and LVH, especially among the elderly. The elevation of atrial natriuretic peptide (ANP) levels in patients with LAE is thought to associate with nocturia. ANP increases the glomerular filtration rate (GFR), renal plasma flow and sodium excretion, which cause diuresis and natriuresis. LVH increases the risks of both systolic and diastolic heart failure, which leads to nocturia.

Patients with old age, diabetes, and echocardiographic evidence of LAE and LVH had higher times of nocturia. Moreover, nocturia could be predictive of structural heart disease including LAE and LVH. Referral to cardiologists should be considered for nocturia patients without other significant LUTS.

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Continence 2S2 (2022) 100338
DOI: 10.1016/j.cont.2022.100338