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


Primary 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. We 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. At 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. Treatment 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.

Authors: Troy H. Puar, Chin Kai Cheong, Roger S.Y. Foo, Seyed Ehsan Saffari, Tian Ming Tu, Min Ru Chee, Meifen Zhang, Keng Sin Ng, Kang Min Wong, Andrew Wong, Foo Cheong Ng, Tar Choon Aw, Joan Khoo, Linsey Gani, Thomas King, Wann Jia Loh, Shui Boon Soh, Vanessa Au, Tunn Lin Tay, Eberta Tan, Lily Mae, Jielin Yew, Yen Kheng Tan, Khim Leng Tong, Sheldon Lee, Siang Chew Chai
Keywords: left ventricular systolic function, treatment outcome
DOI Number: 10.3389/fendo.2022.916744      Publication Year: 2022

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