Hidaka Takayuki, Shiwa Tsuguka, Fujii Yuichi, Nishioka Kenji, Utsunomiya Hiroto, Ishibashi Ken, Mitsuba Naoya, Dohi Yoshihiro, Oda Noboru, Noma Kensuke, Kurisu Satoru, Nakano Yukiko, Yamamoto Hideya, Iishida Takafumi, Higashi Yukihito, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences and Health, Kasumi 1-2-3, Minami-ku, Hiroshima Japan.
J Echocardiogr. 2013;11(4):123-9. doi: 10.1007/s12574-013-0168-y. Epub 2013 Feb 5.
Primary aldosteronism (PA) is a most common cause of secondary hypertension. In PA, left ventricular hypertrophy (LVH) is more progressive than in any other cause of hypertension. Aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) are major subtypes of PA. However there is little information concerned with differences of cardiac structures between these two subtypes.
We reviewed echocardiographic findings in 46 patients with PA. All patients had a positive screen test and subtypes of PA were confirmed by adrenal vein sampling. Subjects consisted of 20 patients with APA (APA group, 52.4 ± 10.8 years) and 26 patients with IHA (IHA group, 56.2 ± 9.5 years). We investigated differences of cardiac structures and functions in the left atrium and ventricle between the APA group and IHA group.
In terms of clinical characteristics, the height and duration of hypertension were greater and serum potassium concentration and BMI were lower in the APA group than in the IHA group. Plasma aldosterone concentration (PAC) and PAC to plasma renin activity ratio were higher in the APA group than in the IHA group. In echocardiographic assessment, the left atrial volume, left ventricular end-diastolic and end-systolic diameters, left ventricular mass (LVM), and prevalence of LVH were greater in the APA group than in the IHA group. Multiple linear regression analysis revealed that the diagnosis of APA independently correlated with left atrial volume, left ventricular end-diastolic diameter, and LVM.
We demonstrated that differences of cardiac structures between the APA group and IHA group existed. In APA, left atrial enlargement and LVH were more prominent than in IHA.
原发性醛固酮增多症（PA）是继发性高血压最常见的病因。在PA中，左心室肥厚（LVH）比其他任何高血压病因进展更快。醛固酮瘤（APA）和特发性醛固酮增多症（IHA）是PA的主要亚型。然而，关于这两种亚型之间心脏结构差异的信息很少。
我们回顾了46例PA患者的超声心动图检查结果。所有患者筛查试验均为阳性，PA亚型经肾上腺静脉采血确诊。研究对象包括20例APA患者（APA组，52.4±10.8岁）和26例IHA患者（IHA组，56.2±9.5岁）。我们调查了APA组和IHA组左心房和左心室的心脏结构和功能差异。
在临床特征方面，APA组的高血压病程和血压升高幅度大于IHA组，血清钾浓度和BMI低于IHA组。APA组的血浆醛固酮浓度（PAC）和PAC与血浆肾素活性比值高于IHA组。在超声心动图评估中，APA组的左心房容积、左心室舒张末期和收缩末期直径、左心室质量（LVM）以及LVH患病率均高于IHA组。多元线性回归分析显示，APA诊断与左心房容积、左心室舒张末期直径和LVM独立相关。
我们证明了APA组和IHA组之间存在心脏结构差异。在APA中，左心房扩大和LVH比IHA更明显。
