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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.

Background: In addition to increased cardiovascular risk, patients with primary aldosteronism (PA) also suffer from impaired health–related quality of life (HRQoL) and psychological symptoms. We assessed for changes in HRQoL and depressive symptoms in a cohort of Asian patients with PA, after surgical and medical therapy. Methods: 34 patients with PA were prospectively recruited and completed questionnaires from 2017 to 2020. HRQoL was assessed using RAND–36 and EQ–5D–3L, and depressive symptoms were assessed using Beck Depression Inventory (BDI–II) at baseline, 6 months, and 1 year post–treatment. Results: At 1 year post–treatment, significant improvement was observed in both physical and mental summative scores of RAND–36, +3.65, P=0.023, and +3.41, P=0.033, respectively, as well as four subscale domains (physical functioning, bodily pain, role emotional and mental health). Significant improvement was also seen in EQ–5D dimension of anxiety/depression at 1 year post–treatment. Patients treated with surgery (N=21) had significant improvement in EQ–5D index score post–treatment, and better EQ–5D outcomes compared to medical group (N=13) at 1 year post–treatment. 37.9%, 41.6% and 58.6% of patients had symptoms in the cognitive, affective and somatic domains of BDI–II respectively. There was significant improvement in the affective domain of BDI–II at 1 year post–treatment. Conclusion: Both surgical and medical therapy improve HRQoL and psychological symptoms in patients with PA, with surgery providing better outcomes. This highlights the importance of early diagnosis, accurate subtyping and appropriate treatment of PA.