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

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 echocar...

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Published inFrontiers in endocrinology (Lausanne) Vol. 13; p. 916744
Main Authors Puar, Troy H., Cheong, Chin Kai, Foo, Roger S.Y., Saffari, Seyed Ehsan, Tu, Tian Ming, Chee, Min Ru, Zhang, Meifen, Ng, Keng Sin, Wong, Kang Min, Wong, Andrew, Ng, Foo Cheong, Aw, Tar Choon, Khoo, Joan, Gani, Linsey, King, Thomas, Loh, Wann Jia, Soh, Shui Boon, Au, Vanessa, Tay, Tunn Lin, Tan, Eberta, Mae, Lily, Yew, Jielin, Tan, Yen Kheng, Tong, Khim Leng, Lee, Sheldon, Chai, Siang Chew
Format Journal Article
LanguageEnglish
Published Frontiers Media S.A 30.06.2022
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Summary: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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This article was submitted to Adrenal Endocrinology, a section of the journal Frontiers in Endocrinology
These authors have contributed equally to this work
Reviewed by: Jacopo Burrello, University of Turin, Italy; Francesca Pizzolo, University of Verona, Italy
Edited by: Silvia Monticone, University of Turin, Italy
ISSN:1664-2392
1664-2392
DOI:10.3389/fendo.2022.916744