Department of Clinical Science, University of Bergen.
Department of Heart Disease.
J Hypertens. 2022 Jun 1;40(6):1204-1211. doi: 10.1097/HJH.0000000000003135. Epub 2022 Mar 11.
We compared persistent cardiac organ damage in patients treated surgically or medically for primary aldosteronism.
Eighty-four patients (age 57 ± 11 years, 27% women) with primary aldosteronism underwent echocardiography at time of diagnosis and after one year of treatment (49% adrenalectomy, 51% medical treatment). Persistent cardiac organ damage was defined as presence of left ventricle (LV) hypertrophy, low LV midwall shortening, global longitudinal strain and/or enlarged left atrium both at baseline and at follow-up.
At one year, a significant regression of LV hypertrophy was observed in surgically (44 vs. 22%, P = 0.039), but not in medically treated patients (60 vs. 51%, P = 0.206). The prevalence of enlarged left atrium was reduced in both groups (both P < 0.001), whereas systolic myocardial function remained unchanged. In multivariable logistic regression analysis, medical treatment [odds ratio (OR) 4.88 (95% confidence interval (CI) 1.26-18.88)] was a strong predictor of persistent LV hypertrophy independent of higher BMI [OR 1.20 (95% CI 1.04-1.38)] and presence of diabetes [OR 6.48 (95% CI 1.20-34.83), all P < 0.05]. Persistently low midwall shortening was associated with suppressed plasma renin after one year [OR 6.11 (95% CI 1.39-26.7)] and lower renal function [OR 0.96 (95% CI 0.94-0.99), both P < 0.05]. The strongest predictor of persistently low global longitudinal strain was higher HbA1c [OR 2.37 (95% CI 1.12-5.02), P = 0.024].
Persistent cardiac organ damage was more common in the medical treatment group and associated with incomplete aldosterone blockade, impaired renal function and presence of metabolic comorbidities.
我们比较了原发性醛固酮增多症患者手术治疗和药物治疗后的持续性心脏器官损伤。
84 例原发性醛固酮增多症患者（年龄 57±11 岁，27%为女性）在诊断时和治疗 1 年后行超声心动图检查（49%行肾上腺切除术，51%行药物治疗）。持续性心脏器官损伤定义为在基线和随访时均存在左心室（LV）肥厚、LV 中层缩短不良、整体纵向应变和/或左心房扩大。
在 1 年时，手术治疗组的 LV 肥厚显著消退（44%比 22%，P=0.039），而药物治疗组则无显著消退（60%比 51%，P=0.206）。两组左心房扩大的发生率均降低（均 P<0.001），而心肌收缩功能无变化。多变量逻辑回归分析显示，药物治疗[比值比（OR）4.88（95%置信区间（CI）1.26-18.88）]是持续性 LV 肥厚的独立强预测因素，独立于较高的 BMI[OR 1.20（95%CI 1.04-1.38）]和糖尿病的存在[OR 6.48（95%CI 1.20-34.83）]，均 P<0.05]。持续性中层缩短不良与治疗 1 年后血浆肾素抑制相关[OR 6.11（95%CI 1.39-26.7）]和肾功能降低相关[OR 0.96（95%CI 0.94-0.99）]，均 P<0.05]。持续性整体纵向应变不良的最强预测因素是较高的 HbA1c[OR 2.37（95%CI 1.12-5.02），P=0.024]。
药物治疗组的持续性心脏器官损伤更为常见，与醛固酮不完全阻断、肾功能受损和存在代谢合并症相关。
