Preclinical cardiac disease in women and men with primary aldosteronism

Abstract

Purpose: We tested the sex-specific associations between primary aldosteronism (PA), left ventricular (LV) hypertrophy and LV systolic myocardial function. Material and methods: Conventional and speckle tracking echocardiography was performed in 109 patients with PA and 89 controls with essential hypertension (EH). LV hypertrophy was identified if LV mass index exceeded 47.0 g/m 2.7 in women and 50.0 g/m 2.7 in men. LV systolic myocardial function was assessed by global longitudinal strain (GLS) and midwall shortening. Results: PA patients had higher prevalence of LV hypertrophy (52 vs. 21%, p < 0.001) than EH patients in both sexes, while GLS did not differ by sex or hypertension aetiology. In multivariable analyses, presence of LV hypertrophy was associated with PA and obesity in both sexes, while lower systolic myocardial function, whether measured by GLS or midwall shortening, was not associated with PA, but primarily with higher body mass index and LV mass index, respectively, in both sexes (all p < 0.05). Conclusion: Having PA was associated with higher prevalence of LV hypertrophy both in women and men, compared to EH. PA was not associated with LV systolic myocardial function in either sex.

Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism

“…Exclusive analysis of a prospective study confirmed the association of PA with higher LV internal dimensions and higher LVMI compared with those in subjects with EH (104). Besides, the prevalence of LVH had no significant gender difference in patients with PA (105). What is more, Chen et al demonstrated that patients with PA showed not only LV abnormalities but also impaired right ventricular function because of hyper aldosteronism (106).…”

Persistent cardiac organ damage in surgically and medically treated primary aldosteronism

“…Primary aldosteronism was confirmed by recumbent saline infusion testing (SIT), and subtype differentiation was done by cosyntropin-stimulated adrenal vein sampling in all patients, as previously described, and in accordance with current guidelines [3,10]. Interfering antihypertensive medication was withdrawn and replaced by noninterfering medication (primarily doxazosin and/or verapamil) 2-4 weeks prior to diagnostic work up at baseline.…”

“…Conventional and two-dimensional speckle tracking echocardiography were performed following a standardized imaging protocol using a GE Vivid E9 scanner (GE Vingmed Ultrasound, Horten, Norway). Images were postprocessed in the Echocardiography Core laboratory at the University of Bergen, Norway, on workstations equipped with Image Arena Software version 4.2 (TomTec Imaging Systems GmbH, Unterschleißheim, Germany) for conventional measurements and EchoPac software version BT202 (GE Vingmed Ultrasound) for two-dimensional speckle tracking echocardiography as previously reported [10]. Images were analyzed by the same investigator and proofread by a single expert reader following current guidelines for chamber quantification [16].…”

“…In primary aldosteronism, this has in particular been demonstrated for left ventricular (LV) hypertrophy, which is highly prevalent [8][9][10]. However, although most studies on primary aldosteronism have focused exclusively on LV hypertrophy, some studies have shown that also left atrial enlargement, a risk factor for atrial fibrillation and stroke, and LV myocardial dysfunction, a precursor of heart failure, are common types of cardiac organ damage in primary aldosteronism [8][9][10]. An essential goal of specific treatment in primary aldosteronism is to prevent cardiovascular complications, and thus regression of cardiac organ damage is crucial [11].…”

“…Cardiac organ damage is well documented as a precursor of clinical cardiovascular events in essential hypertension [4][5][6][7]. In primary aldosteronism, this has in particular been demonstrated for left ventricular (LV) hypertrophy, which is highly prevalent [8][9][10]. However, although most studies on primary aldosteronism have focused exclusively on LV hypertrophy, some studies have shown that also left atrial enlargement, a risk factor for atrial fibrillation and stroke, and LV myocardial dysfunction, a precursor of heart failure, are common types of cardiac organ damage in primary aldosteronism [8][9][10].…”