Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan.
Ultrasound Med Biol. 2013 Jan;39(1):54-61. doi: 10.1016/j.ultrasmedbio.2012.08.023.
Primary aldosteronism (PA), an underdiagnosed cause of hypertension, is associated with more significant cardiac remodeling and myocardial fibrosis than is essential hypertension (EH). The aim of this study was to validate myocardial fibrosis and to evaluate factors associated with the degree of myocardial fibrosis in patients with PA. We prospectively analyzed 62 patients with PA (including 46 patients with aldosterone-producing adenoma and 16 with bilateral hyperplasia) between October 2006 and October 2010, and we enrolled 17 patients with EH as the control group. Echocardiography, including ultrasonic tissue characterization using cyclic variation of integrated backscatter (CVIBS), was performed in individuals in both groups. Among patients with PA, the diastolic blood pressures and plasma aldosterone concentrations were significantly higher than those of patients with EH. Moreover, the serum potassium levels and the plasma renin activities were significantly lower in patients with EH. As observed by echocardiography, patients with PA had greater interventricular septal thickness, greater left ventricular posterior wall thickness, and higher left ventricular mass indexes than did patients with EH. Patients with PA had significantly lower CVIBS values than patients with EH (7.1 ± 2.2 vs. 8.7 ± 1.5 dB; p = .005). In a correlation study that corrected for various clinical parameters, only log-transformed plasma renin activity values correlated significantly with CVIBS values. Ultrasonic tissue characterization with CVIBS is a useful tool for determining the extent of myocardial fibrosis. Patients with PA exhibit a more severe degree of myocardial fibrosis, as detected by CVIBS, than do patients with EH. Moreover, the severity of fibrosis, as detected by CVIBS, correlates with log-transformed plasma renin activity values.
原发性醛固酮增多症（PA）是一种未被充分诊断的高血压病因，与原发性高血压（EH）相比，它与更显著的心脏重构和心肌纤维化相关。本研究的目的是验证心肌纤维化，并评估与 PA 患者心肌纤维化程度相关的因素。我们前瞻性分析了 2006 年 10 月至 2010 年 10 月期间的 62 例 PA 患者（包括 46 例醛固酮瘤患者和 16 例双侧增生患者），并纳入 17 例 EH 患者作为对照组。两组个体均进行超声心动图检查，包括利用背向散射积分循环变化的超声组织特征（CVIBS）。PA 患者的舒张压和血浆醛固酮浓度明显高于 EH 患者，而 EH 患者的血清钾水平和血浆肾素活性明显低于 PA 患者。超声心动图观察到，PA 患者的室间隔厚度、左心室后壁厚度和左心室质量指数均大于 EH 患者。PA 患者的 CVIBS 值明显低于 EH 患者（7.1 ± 2.2 比 8.7 ± 1.5 dB；p =.005）。在一项校正了各种临床参数的相关性研究中，只有对数转换后的血浆肾素活性值与 CVIBS 值显著相关。CVIBS 的超声组织特征是确定心肌纤维化程度的有用工具。与 EH 患者相比，PA 患者的 CVIBS 检测到更严重的心肌纤维化程度。此外，CVIBS 检测到的纤维化严重程度与对数转换后的血浆肾素活性值相关。
