斑点追踪超声心动图评估原发性醛固酮增多症患者的左心房心肌功能障碍。

Left atrial myocardial dysfunction in patients with primary aldosteronism as assessed by speckle-tracking echocardiography.

机构信息

The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital.

Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

J Hypertens. 2019 Oct;37(10):2032-2040. doi: 10.1097/HJH.0000000000002146.

DOI:10.1097/HJH.0000000000002146

PMID:31157742

Abstract

BACKGROUND

We investigated the left atrial myocardial deformation in patients with primary aldosteronism using the speckle-tracking echocardiographic (STE) strain imaging technique.

METHODS

Our study included 107 primary aldosteronism patients [52 aldosterone-producing adenoma (APA) and 55 idiopathic hyperaldosteronism (IHA)] and 50 primary hypertensive patients. We performed conventional echocardiography to measure left atrial volume and ejection fraction, and STE to estimate left atrial myocardial deformation including peak velocity, strain and strain rate and calculate the ratio of E/e' to left atrial strain during left ventricular systole as the left atrial stiffness index.

RESULTS

Patients with APA, compared with those with IHA and primary hypertension had a significantly (P < 0.001) lower serum potassium concentration and higher 24-h urinary aldosterone excretion and plasma aldosterone-to-renin ratio. Patients with APA had a significantly (P < 0.01) larger maximal, precontraction, and minimal left atrial volumes and lower total, active and passive left atrial emptying fractions than those with IHA and primary hypertension. Among the three groups, patients with APA showed lowest left atrial velocity, strain, and strain rate during ventricular systole, early diastole and late diastole (P < 0.05) and highest left atrial stiffness index (P < 0.001). In unadjusted analysis, the left atrial strain, strain rate and stiffness index were significantly (P < 0.05) associated with plasma aldosterone concentration and urinary aldosterone excretion. After adjustment for various confounding factors, these associations remained statistically significant for urinary aldosterone excretion (P < 0.05) but not plasma aldosterone concentration (P ≥ 0.05).

CONCLUSION

Patients with primary aldosteronism, especially APA, had impaired left atrial deformation mechanics and increased left atrial stiffness, providing a promising insight into early detection of subclinical left atrial dysfunction by strain echocardiography.

摘要

背景

我们使用斑点追踪超声心动图（STE）应变成像技术研究了原发性醛固酮增多症患者的左心房心肌变形。

方法

本研究纳入了 107 例原发性醛固酮增多症患者（52 例醛固酮瘤（APA）和 55 例特发性醛固酮增多症（IHA））和 50 例原发性高血压患者。我们进行了常规超声心动图检查以测量左心房容积和射血分数，并使用 STE 估计左心房心肌变形，包括峰值速度、应变和应变率，并计算左心室收缩期左心房应变与 E/e'的比值作为左心房僵硬度指数。

结果

与 IHA 和原发性高血压患者相比，APA 患者的血清钾浓度明显降低（P < 0.001），24 小时尿醛固酮排泄量和血浆醛固酮/肾素比值明显升高（P < 0.001）。APA 患者的最大、预收缩和最小左心房容积明显大于 IHA 和原发性高血压患者（P < 0.01），总、主动和被动左心房排空分数明显降低（P < 0.01）。在三组患者中，APA 患者的左心房收缩期、早期舒张期和晚期舒张期的速度、应变和应变率最低（P < 0.05），左心房僵硬度指数最高（P < 0.001）。在未校正分析中，左心房应变、应变率和僵硬度指数与血浆醛固酮浓度和尿醛固酮排泄量显著相关（P < 0.05）。校正了各种混杂因素后，这些相关性在尿醛固酮排泄量方面仍然具有统计学意义（P < 0.05），而在血浆醛固酮浓度方面则无统计学意义（P ≥ 0.05）。