The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism

Liao, Min-Tsun; Wu, Xue-Ming; Chang, Chin‐Chen; Liao, Che‐Wei; Chen, Ming-Fong; Lu, Ching‐Chu; Lin, Yen‐Ting; Chang, Yuan‐Jen; Hung, Chi‐Sheng; Lin, Lung‐Chun; Lai, Chao‐Lun; Lin, Lian‐Yu; Wu, Vin‐Cent; Ho, Yi‐Lwun; Wu, Kwan‐Dun; Lin, Yen‐Hung

doi:10.7150/ijms.10975

Cited by 8 publications

(9 citation statements)

References 51 publications

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“…Among PA patients, LVMI has been correlated with blood pressure [12], serum potassium level [68], estimated glomerular filtration rate [74], and urine sodium levels [75]. Changes in systolic blood pressure (SBP), postoperative SBP, pre-operative LVMI, and postoperative potassium have been correlated with changes in LVMI [66,68].…”

Section: Clinical Studies Of Pa and Treatment Effects On Lvhmentioning

confidence: 99%

Left ventricular remodeling and dysfunction in primary aldosteronism

et al. 2020

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Primary aldosteronism (PA) is a common cause of secondary hypertension and is associated with worse cardiovascular outcomes. The elevated aldosterone in PA leads to left ventricular (LV) remodeling and dysfunction. In recent decades, clinical studies have demonstrated worse LV remodeling including increased LV mass and cardiac fibrosis in patients with PA compared to patients with essential hypertension. Several mechanisms may explain the process of aldosterone-induced LV remodeling, including directly profibrotic and hypertrophic effects of aldosterone on myocardium, increased reactive oxygen species and profibrotic molecules, dysregulation of extracellular matrix metabolism, endothelium dysfunction and circulatory macrophages activation. LV remodeling causes LV diastolic and systolic dysfunction, which may consequently lead to clinical complications such as heart failure, atrial fibrillation, ischemic heart disease, and other vascular events. Adequate treatment with adrenalectomy or medical therapy can improve LV remodeling and dysfunction in PA patients. In this review, we discuss the mechanisms of aldosterone-induced LV remodeling and provide an up-to-date review of clinical research about LV remodeling-related heart structural changes, cardiac dysfunction, and their clinical impacts on patients with PA.

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Section: Clinical Studies Of Pa and Treatment Effects On Lvhmentioning

confidence: 99%

Left ventricular remodeling and dysfunction in primary aldosteronism

et al. 2020

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“…The cardiac chambers enlarge to deliver the enormous stroke volume, but extremely high cardiac outputs can only be sustained at the price of marked increases in cardiac diastolic pressures . The resulting phenotype is characterized by markedly elevated cardiac indexes, left ventricular dilatation, meaningfully increased right and left ventricular filling pressures and levels of N‐terminal proBNP (despite obesity), and high glomerular filtration rates . These features typify the clinical features of high‐output heart failure (HOHF) in obese people.…”

Section: Evolution Of High‐output Heart Failure In Obese Peoplementioning

confidence: 99%

“…However, if the degree of cardiomyocyte stretch is exaggerated by maintenance of dietary sodium and if continued plasma volume expansion were to accelerate the release of BNP in excess of the degradative capacity of adipocyte‐related neprilysin, the resulting systemic vasodilatation could precipitate a state of HOHF . In addition, potentiation of the effects of endogenous natriuretic peptides could reduce afferent arteriolar resistance and promote proximal renal tubular reabsorption; both actions can explain the glomerular hyperfiltration that is typically seen in obesity‐related HOHF …”

Section: Evolution Of High‐output Heart Failure In Obese Peoplementioning

confidence: 99%

“…62,63 The resulting phenotype is characterized by markedly elevated cardiac indexes, left ventricular dilatation, meaningfully increased right and left ventricular filling pressures and levels of N-terminal proBNP (despite obesity), and high glomerular filtration rates. 32,64,65 These features typify the clinical features of high-output heart failure (HOHF) in obese people. The hypervolaemia-related hyperdynamic state in these patients is striking, as is evidenced by the fact that -among patients with many different causes of HOHF (including those with arteriovenous shunts) -plasma volume expansion, left ventricular chamber dimensions and glomerular filtration rates are the most elevated in those whose HOHF is related to obesity.…”

Section: Evolution Of High-output Heart Failure In Obese Peoplementioning

confidence: 99%

“…64 In addition, potentiation of the effects of endogenous natriuretic peptides could reduce afferent arteriolar resistance and promote proximal renal tubular reabsorption; both actions can explain the glomerular hyperfiltration that is typically seen in obesity-related HOHF. 65…”

Section: Evolution Of High-output Heart Failure In Obese Peoplementioning

confidence: 99%

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The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range

Packer

2018

European J of Heart Fail

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Patients with obesity, a reduced exercise capacity, increased cardiac filling pressures and a measured left ventricular ejection fraction in the normal range do not have a homogeneous disorder, but instead, exhibit one of three phenotypes. First, many obese people exhibit sodium retention, plasma volume expansion and cardiac enlargement, and some are likely to have heart failure that is related to hypervolaemia, even though cardiac index and circulating levels of natriuretic peptides are not meaningfully increased. Second, in some middle‐aged men and women (particularly those with minimal co‐morbidities), levels of natriuretic peptides increase markedly and can lower systemic vascular resistance, thus leading to high‐output heart failure (HOHF) and glomerular hyperfiltration. Third, older obese people, particularly women with multiple co‐morbidities, exhibit the syndrome of heart failure with a preserved ejection fraction (HFpEF). Despite degrees of plasma volume expansion similar to HOHF, these patients exhibit only modestly increased ventricular dimensions and circulating levels of natriuretic peptides (despite a high prevalence of atrial fibrillation), and glomerular function is characteristically impaired. A conceptual framework is proposed to distinguish among the three phenotypes seen in obese patients with exercise intolerance, increased ventricular filling pressures and a measured left ventricular ejection fraction in the normal range, since they may respond differently to therapeutic interventions. Efforts are needed to enhance the recognition of heart failure in obese people and to ensure that clinical trials that are designed to study patients with HFpEF actually enrol those who have the disease.

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Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry

Araujo-Castro,

Paja Fano,

González-Boillos

et al. 2024

Journal of Hypertension

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Aim: To evaluate the impact of aldosterone excess on renal function in individuals with primary aldosteronism and to compare its evolution after surgery or mineralocorticoid receptor antagonist (MRA) treatment. Methods: A multicentre, retrospective cohort study of primary aldosteronism patients in follow-up in 36 Spanish tertiary hospitals, who underwent specific treatment for primary aldosteronism (MRA or adrenalectomy). Results: A total of 789 patients with primary aldosteronism were included, with a median age of 57.5 years and 41.8% being women. At primary aldosteronism diagnosis, the prevalence of chronic kidney disease (CKD) was 10.7% (n = 84), with 75% of cases classified as state 3a (n = 63). Primary aldosteronism patients with CKD had a longer duration of hypertension, a higher prevalence of type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. Unilateral adrenalectomy was performed in 41.8% of cases (n = 330), and 459 patients were treated with MRA. After a median follow-up of 30.7 months (range 13.3–68.4), there was a significant decline in the estimated glomerular filtration rate (eGFR) in operated patients and those receiving MRA. During follow-up, 24.4% of patients with CKD at the time of primary aldosteronism diagnosis had normalized renal function, and 39% of those with albuminuria had albuminuria remission. There were no differences in renal function or albuminuria regression between the two therapy groups. However, development of albuminuria was less common in operated than in medically treated patients (0 vs. 6.0%, P = 0.009). Conclusion: CKD affects around 10% of the patients with primary aldosteronism, with a higher risk in individuals with long-term hypertension, type 2 diabetes, dyslipidaemia, cardiovascular events, hypokalaemia, and albuminuria. At short-term, both MRA and surgical treatment lead to a reduction of renal function, but adrenalectomy led to higher renal protection.

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The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism

Cited by 8 publications

References 51 publications

Left ventricular remodeling and dysfunction in primary aldosteronism

Left ventricular remodeling and dysfunction in primary aldosteronism

The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range

Impact of primary aldosteronism on kidney function: results from the SPAIN-ALDO registry

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