Left Ventricular Dysfunction in Patients With Primary Aldosteronism: A Propensity Score–Matching Follow‐Up Study With Tissue Doppler Imaging

Abstract

BackgroundPrimary aldosteronism is the most common cause of secondary hypertension and is associated with left ventricular hypertrophy. However, whether aldosterone excess is responsible for left ventricular (LV) diastolic dysfunction is unknown.Methods and ResultsWe prospectively enrolled 129 patients with aldosterone‐producing adenoma and 120 patients with essential hypertension, and analyzed their clinical, biochemical, and echocardiographic data, including tissue Doppler images. The patients with aldosterone‐producing adenoma were reevaluated 1 year after adrenalectomy. After propensity score matching, there were 105 patients in each group. The patients with aldosterone‐producing adenoma had worse diastolic function than the patients with essential hypertension, as reflected by lower e′ (P<0.001) and higher E/e′ (P=0.003). Multivariate analysis showed that LV diastolic function was significantly correlated with age (P<0.001), sex (P<0.001), body mass index (P=0.002), systolic blood pressure (P=0.004), creatinine (P=0.008), and log‐transformed aldosterone‐renin ratio (P=0.003). After adrenalectomy, the patients with aldosterone‐producing adenoma had significant improvements in LV diastolic function as reflected by an increase in e′ (P=0.003) and decrease in E/e′ (P=0.002). The change in E/e′ was independently correlated with baseline E/e′ (P<0.001) and change in LV mass index (P=0.006).ConclusionsThe patients with primary aldosteronism had worse LV diastolic function than the patients with essential hypertension after propensity score matching, and this could be reversed after adrenalectomy, suggesting that aldosterone excess may induce LV diastolic dysfunction.

Left ventricular remodeling and dysfunction in primary aldosteronism

“…In another study of 24 PA patients who underwent adrenalectomy, diastolic function as assessed by E/A ratio and DT improved, but without statistical significance [62]. In our recent study [93], diastolic function improved after adrenalectomy in the APA patients as evidenced by a significant increase in Em and significant decrease in E/Em ratio. The improvement in diastolic function after adrenalectomy was associated with baseline E/Em and changes in LVMI after adrenalectomy.…”

“…However, the severity of diastolic dysfunction is proportional to blood pressure [92]. In our recent study [93], we used propensity score matching analysis to mitigate the effect of blood pressure on diastolic function between aldosterone-producing adenomas (APA) and EH patients. There were 105 patients in each group after matching, and the APA patients had significantly worse diastolic function than the EH patients, as reflected by a lower Em and higher E/Em.…”

“…With regards to the treatment effect of PA on cardiac function, although both adrenalectomy and spironolactone have been shown to be effective in reducing LV mass, no significant changes in LVEF, eFS, or mFS have been shown after treatment [62,84,91,93,112,113]. To date, no strain study has assessed the effect of treatment in PA patients.…”

Atrial Fibrillation in Primary Aldosteronism

“…In addition, the improvement after adrenalectomy was seen in both reversal of left ventricular geometry and also alterations in myocardial texture, as shown by increased cyclic variation of integrated backscatter (CVIBS) and decreased plasma carboxy-terminal propeptide of procollagen type I (PICP) level [88]. We also previously reported that aldosterone-induced left ventricular diastolic dysfunction could be reversed after adrenalectomy [89]. Because of the close relation between left ventricular structure/function and AF genesis, improvement of left ventricular structure/function after PA target treatment may further decrease AF burden.…”

The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism

“…The excess of plasma aldosterone correlated with LVH, early diastolic dysfunction [ 137 , 138 ], and left ventricular enlargement with evidence of subclinical systolic dysfunction [ 139 ], In a prospective study of patients who underwent left heart catheterization due to different cardiac diseases, those with AF and hypertensive cardiomyopathy showed an increased ARR [ 140 ]. The increase in LVH in PA patients was confirmed in a meta-analysis that compared patients with PA and essential hypertension [ 141 ].…”