Improved adrenal vein sampling from a dedicated programme: experience of a low-volume single centre in Singapore

Tan, Min-On; Puar, Troy; Swaminathan, Saravana Kumar; Tay, Yu‐Kwang Donovan; Aw, Tar Choon; Lim, David Yurui; Shi, Haiyuan; Dacay, Lily Mae; Zhang, Meifen; Khoo, Joan; Ng, Keng Sin

doi:10.11622/smedj.2020171

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Thin-sliced computed tomography (CT) of the adrenal glands was performed in all patients. In patients keen to undergo unilateral adrenalectomy, adrenal vein sampling (AVS) was performed sequentially under continuous corticotropin infusion by an experienced interventional radiologist (KSN) in majority of cases ( 14 ). Samples were taken from both adrenal veins and infrarenal vena cava (peripheral vein).…”

Section: Methodsmentioning

confidence: 99%

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

et al. 2022

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IntroductionPrimary aldosteronism (PA) is associated with increased risk of cardiovascular events. However, treatment of PA has not been shown to improve left ventricular (LV) systolic function using the conventional assessment with LV ejection fraction (LVEF). We aim to use speckle-tracking echocardiography to assess for improvement in subclinical systolic function after treatment of PA.MethodsWe prospectively recruited 57 patients with PA, who underwent 24-h ambulatory blood pressure (BP) measurements and echocardiography, including global longitudinal strain (GLS) assessment of left ventricle, at baseline and 12 months post-treatment.ResultsAt baseline, GLS was low in 14 of 50 (28.0%) patients. On multivariable analysis, GLS was associated with diastolic BP (P = 0.038) and glomerular filtration rate (P = 0.026). GLS improved post-surgery by −2.3, 95% CI: −3.9 to −0.6, P = 0.010, and post-medications by −1.3, 95% CI: −2.6 to 0.03, P = 0.089, whereas there were no changes in LVEF in either group. Improvement in GLS was independently correlated with baseline GLS (P < 0.001) and increase in plasma renin activity (P = 0.007). Patients with post-treatment plasma renin activity ≥1 ng/ml/h had improvements in GLS (P = 0.0019), whereas patients with persistently suppressed renin had no improvement. Post-adrenalectomy, there were also improvements in LV mass index (P = 0.012), left atrial volume index (P = 0.002), and mitral E/e’ (P = 0.006), whereas it was not statistically significant in patients treated with medications.ConclusionTreatment of hyperaldosteronism is effective in improving subclinical LV systolic dysfunction. Elevation of renin levels after treatment, which reflects adequate reversal of sodium overload state, is associated with better systolic function after treatment.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03174847.

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Section: Methodsmentioning

confidence: 99%