Reiser Carolina S, Assuncao Antonildes N, Araujo-Filho Jose A B, Dantas Roberto N, Bortolotto Luiz A, Parga-Filho Jose R
Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil.
PLoS One. 2024 Dec 23;19(12):e0316140. doi: 10.1371/journal.pone.0316140. eCollection 2024.
Increased cardiac after load and multiple non-hemodynamic stimuli implicate in adverse left ventricular remodeling (LVR). This is particularly identifiable in treatment-resistant and secondary hypertension contexts, like primary hyperaldosteronism (PA), however little data exists on post-treatment residual LVR in these individuals.
Cardiac magnetic resonance (CMR) with T1 mapping were performed in 14 patients with treated PA matched with 15 treated patients with primary hypertension (PH) and 15 healthy individuals. Blood pressure (BP) control was defined as < 140 x 90mmHg.
Treated PA and PH patients had similar indexed left ventricular, extracellular matrix and intracellular masses (respectively 68 ± 12g/m2, 17 ± 3g/m2 and 52 ± 10g/m2 for PA vs 63 ± 18g/m2, 16 ± 5g/m2 and 47 ± 14g/m2 for PH, p > 0.05 for all), that were significantly higher than normal individuals (47 ± 8g/m2, 11 ± 2g/m2 and 36 ± 6g/m2, respectively, p < 0.05 for all). Patients with uncontrolled BP exhibited greater cardiomyocyte hypertrophy than those controlled (55 ± 11 g/m2 vs 43 ± 11 g/m2, p = 0.01), regardless of the cause of hypertension. PH individuals had strong correlations between BP measurements and LVR parameters of the CMR, while in PA correlations were weaker.
In treated patients with PA and PH, CMR detected similar residual tissue LVR in both groups. Uncontrolled BP was more related to the observed LVR than to the etiology of hypertension. BP levels were more strongly correlated to CMR LVR parameters in PH than PA patients.
心脏后负荷增加和多种非血流动力学刺激因素与不良左心室重构（LVR）有关。这在治疗抵抗性和继发性高血压情况下尤为明显，如原发性醛固酮增多症（PA），然而关于这些个体治疗后残余LVR的数据很少。
对14例接受治疗的PA患者、15例接受治疗的原发性高血压（PH）患者和15名健康个体进行了T1映射心脏磁共振成像（CMR）检查。血压（BP）控制定义为<140×90mmHg。
接受治疗的PA和PH患者的左心室指数、细胞外基质和细胞内质量相似（PA组分别为68±12g/m²、17±3g/m²和52±10g/m²，PH组分别为63±18g/m²、16±5g/m²和47±14g/m²，所有p>0.05），均显著高于正常个体（分别为47±8g/m²、11±2g/m²和36±6g/m²，所有p<0.05）。无论高血压病因如何，血压未得到控制的患者比血压得到控制的患者表现出更大程度的心肌细胞肥大（55±11g/m²对43±11g/m²，p=0.01）。PH个体的血压测量值与CMR的LVR参数之间存在强相关性，而在PA中相关性较弱。
在接受治疗的PA和PH患者中，CMR在两组中检测到相似的残余组织LVR。血压未得到控制与观察到的LVR的关系比与高血压病因的关系更大。与PA患者相比，PH患者的血压水平与CMR LVR参数的相关性更强。
