Higuchi Satoshi, Ota Hideki, Tezuka Yuta, Seiji Kazumasa, Takagi Hidenobu, Lee Jongmin, Lee Yi-Wei, Omata Kei, Ono Yoshikiyo, Morimoto Ryo, Kudo Masataka, Satoh Fumitoshi, Takase Kei
Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan.
Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Endocr Connect. 2021 Jan;10(1):29-36. doi: 10.1530/EC-20-0504.
This study compared cardiac function, morphology, and tissue characteristics between two common subtypes of primary aldosteronism (PA) using a 3T MR scanner.
A retrospective, single-center, observational study.
We retrospectively reviewed 143 consecutive patients with PA, who underwent both adrenal venous sampling and cardiac magnetic resonance. We acquired cine, late gadolinium enhancement, and pre- and postcontrast myocardial T1-mapping images.
PA was diagnosed as unilateral aldosterone-producing adenoma (APA) in 70 patients and bilateral hyperaldosteronism (BHA) in 73. The APA group showed significantly higher plasma aldosterone concentration (PAC) and aldosterone to renin rate (ARR) than the BHA group. After controlling for age, sex, antihypertensive drugs, systolic and diastolic blood pressure, and disease duration, the parameters independently associated with APA were: left ventricular end-diastolic volume index (EDVI: adjusted odds ratio (aOR) = 1.06 (95% CI: 1.030-1.096), P < 0.01), end-systolic volume index (ESVI: 1.06 (1.017-1.113), P < 0.01), stroke index (SI: 1.07 (1.020-1.121), P < 0.01), cardiac index (CI: 1.001 (1.000-1.001), P < 0.01), and native T1 (1.01 (1.000-1.019), P = 0.038). Weak positive correlations were found between PAC and EDVI (R = 0.28, P < 0.01), ESVI (0.26, P < 0.01), and SI (0.18, P = 0.03); and between ARR and EDVI (0.25, P < 0.01), ESVI (0.24, P < 0.01), and native T1 (0.17, P = 0.047).
APA is associated with greater LV volumetric parameters and higher native T1 values, suggesting a higher risk of volume overload and myocardial damage.
本研究使用3T磁共振成像扫描仪比较原发性醛固酮增多症（PA）两种常见亚型之间的心脏功能、形态和组织特征。
一项回顾性、单中心观察性研究。
我们回顾性分析了143例连续的PA患者，这些患者均接受了肾上腺静脉采血和心脏磁共振检查。我们采集了电影成像、延迟钆增强成像以及对比剂注射前后的心肌T1映射图像。
PA在70例患者中被诊断为单侧醛固酮分泌腺瘤（APA），在73例患者中被诊断为双侧醛固酮增多症（BHA）。APA组的血浆醛固酮浓度（PAC）和醛固酮与肾素比值（ARR）显著高于BHA组。在控制年龄、性别、降压药物、收缩压和舒张压以及病程后，与APA独立相关的参数为：左心室舒张末期容积指数（EDVI：调整优势比（aOR）=1.06（95%可信区间：1.030 - 1.096），P<0.01）、收缩末期容积指数（ESVI：1.06（1.017 - 1.113），P<0.01）、每搏输出量指数（SI：1.07（1.020 - 1.121），P<0.01）、心脏指数（CI：1.001（1.000 - 1.001），P<0.01）以及心肌固有T1值（1.01（1.000 - 1.019），P = 0.038）。PAC与EDVI（R = 0.28，P<0.01）、ESVI（0.26，P<0.01）和SI（0.18，P = 0.03）之间存在弱正相关；ARR与EDVI（0.25，P<0.01）、ESVI（0.24，P<0.01）和心肌固有T1值（0.17，P = 0.047）之间也存在弱正相关。
APA与更大的左心室容积参数和更高的心肌固有T1值相关，提示容量超负荷和心肌损伤风险更高。
