Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Front Endocrinol (Lausanne). 2021 Apr 19;12:646097. doi: 10.3389/fendo.2021.646097. eCollection 2021.
Patients with primary aldosteronism (PA) have cardiac remodeling due to hemodynamic and non-hemodynamic causes. However, component analysis of cardiac remodeling and reversal in PA patients is lacking. We investigated components of cardiac remodeling and reversal after adrenalectomy in patients with aldosterone-producing adenoma (APA).
This study prospectively enrolled 304 APA patients who received adrenalectomy and 271 with essential hypertension (EH). Clinical, biochemical and echocardiographic data were collected in both groups and 1 year after surgery in the APA patients. The hemodynamic and non-hemodynamic components of left ventricular (LV) remodeling were represented by predicted left ventricular mass index (LVMI) (pLVMI) and inappropriately excessive LVMI (ieLVMI, defined as LVMI-pLVMI).
After propensity score matching, 213 APA and 213 EH patients were selected. APA patients had higher hemodynamic (pLVMI) and non-hemodynamic (ieLVMI) components of LV remodeling than EH patients. In multivariate analysis, baseline pLVMI was correlated with systolic blood pressure (SBP) and serum potassium, whereas ieLVMI was correlated with log plasma aldosterone concentration but not blood pressure. Post-operative echocardiography was available in 207 patents and showed significant decreases in both pLVMI and ieLVMI after adrenalectomy. In multivariate analysis, ΔpLVMI was correlated with SBP, ΔSBP, and pre-operative pLVMI, whereas ΔieLVMI was correlated with Δlog aldosterone-to-renin ratio (ARR) and pre-operative ieLVMI.
This study concluded that extensive cardiac remodeling in APA patients occurs through hemodynamic and non-hemodynamic causes. Adrenalectomy can improve both hemodynamic and non-hemodynamic components of LV remodeling. Regressions of pLVMI and ieLVMI were correlated with decreases in blood pressure and ARR, respectively.
原醛症（PA）患者存在由血流动力学和非血流动力学因素引起的心脏重构。然而，PA 患者的心脏重构及其逆转的组分分析尚缺乏。我们研究了醛固酮分泌腺瘤（APA）患者肾上腺切除术后心脏重构的组成部分及其逆转。
本前瞻性研究纳入了 304 例接受肾上腺切除术的 APA 患者和 271 例原发性高血压（EH）患者。收集了两组患者的临床、生化和超声心动图数据，并在 APA 患者术后 1 年进行了随访。左心室（LV）重构的血流动力学和非血流动力学成分分别由预测左心室质量指数（LVMI）（pLVMI）和不适当的过度 LVMI（即 LVMI-pLVMI）表示。
经倾向评分匹配后，纳入了 213 例 APA 和 213 例 EH 患者。APA 患者的 LV 重构的血流动力学（pLVMI）和非血流动力学（ieLVMI）成分均高于 EH 患者。多变量分析显示，基线 pLVMI 与收缩压（SBP）和血清钾相关，而 ieLVMI 与血浆醛固酮浓度的对数值相关，但与血压无关。术后超声心动图可用于 207 例患者，结果显示肾上腺切除术后 pLVMI 和 ieLVMI 均显著降低。多变量分析显示，ΔpLVMI 与 SBP、ΔSBP 和术前 pLVMI 相关，而ΔieLVMI 与Δ醛固酮-肾素比值（ARR）和术前 ieLVMI 相关。
本研究表明，APA 患者存在广泛的心脏重构，这是由血流动力学和非血流动力学因素引起的。肾上腺切除术可改善 LV 重构的血流动力学和非血流动力学成分。pLVMI 和 ieLVMI 的回归与血压和 ARR 的降低分别相关。
