Grytaas Marianne Aa, Sellevåg Kjersti, Thordarson Hrafnkell B, Husebye Eystein S, Løvås Kristian, Larsen Terje H
Department of Clinical ScienceUniversity of Bergen, Bergen, Norway
Department of MedicineHaukeland University Hospital, Bergen, Norway.
Endocr Connect. 2018 Mar;7(3):413-424. doi: 10.1530/EC-18-0039. Epub 2018 Feb 12.
Primary aldosteronism (PA) is associated with increased cardiovascular morbidity, presumably due to left ventricular (LV) hypertrophy and fibrosis. However, the degree of fibrosis has not been extensively studied. Cardiac magnetic resonance imaging (CMR) contrast enhancement and novel sensitive T1 mapping to estimate increased extracellular volume (ECV) are available to measure the extent of fibrosis.
To assess LV mass and fibrosis before and after treatment of PA using CMR with contrast enhancement and T1 mapping.
Fifteen patients with newly diagnosed PA (PA1) and 24 age- and sex-matched healthy subjects (HS) were studied by CMR with contrast enhancement. Repeated imaging with a new scanner with T1 mapping was performed in 14 of the PA1 and 20 of the HS median 18 months after specific PA treatment and in additional 16 newly diagnosed PA patients (PA2).
PA1 had higher baseline LV mass index than HS (69 (53-91) vs 51 (40-72) g/m; < 0.001), which decreased significantly after treatment (58 (40-86) g/m; < 0.001 vs baseline), more with adrenalectomy ( = 8; -9 g/m; = 0.003) than with medical treatment ( = 6; -5 g/m; = 0.075). No baseline difference was found in contrast enhancement between PA1 and HS. T1 mapping showed no increase in ECV as a myocardial fibrosis marker in PA. Moreover, ECV was lower in the untreated PA2 than HS 10 min post-contrast, and in both PA groups compared with HS 20 min post-contrast.
Specific treatment rapidly reduced LV mass in PA. Increased myocardial fibrosis was not found and may not represent a common clinical problem.
原发性醛固酮增多症（PA）与心血管疾病发病率增加相关，可能是由于左心室（LV）肥厚和纤维化。然而，纤维化程度尚未得到广泛研究。心脏磁共振成像（CMR）对比增强和用于估计细胞外容积（ECV）增加的新型敏感T1映射可用于测量纤维化程度。
使用CMR对比增强和T1映射评估PA治疗前后的左心室质量和纤维化。
对15例新诊断的PA患者（PA1）和24例年龄和性别匹配的健康受试者（HS）进行CMR对比增强研究。在特定PA治疗后中位18个月，对14例PA1患者和20例HS患者使用具有T1映射的新扫描仪进行重复成像，并对另外16例新诊断的PA患者（PA2）进行成像。
PA1患者的基线左心室质量指数高于HS患者（69（53 - 91）对51（40 - 72）g/m；<0.001），治疗后显著降低（58（40 - 86）g/m；与基线相比<0.001），肾上腺切除术组（=8；-9 g/m；=0.003）比药物治疗组（=6；-5 g/m；=0.075）降低更明显。PA1和HS之间在对比增强方面未发现基线差异。T1映射显示PA中作为心肌纤维化标志物的ECV没有增加。此外，未治疗的PA2患者在对比剂注射后10分钟时的ECV低于HS患者，并且在两个PA组中与对比剂注射后20分钟时的HS患者相比均较低。
特异性治疗可迅速降低PA患者的左心室质量。未发现心肌纤维化增加，可能不代表常见的临床问题。
