Myocardial Mechano-Energetic Efficiency Changes in Primary Aldosteronism Patients

Objective: Cardiac organ damage has been found to be highly prevalent in primary aldosteronism (PA), possibly contributing to the increased risk of cardiovascular events. We reported a lower myocardial mechanoenergetic efficiency index (MEEi) in patients with PA as compared with essential hypertensive patients, possibly reflecting an impairment of production and utilization of energy in the myocardium. We analyze changes of echocardiographic parameters of cardiac anatomy and function, including MEEi, in a group of PA patients with a long-term follow-up (FU). Design and method: One-hundred-sixty-six patients (age 49 ± 10 years, 42% women) with PA underwent echocardiography and clinical evaluation at time of diagnosis and during FU (mean 85 ± 54 months) of treatment (23% adrenalectomy, 77% medical treatment). MEEi was obtained as the ratio between stroke volume and heart rate (HR) and normalized per grams of LV mass and δMEEi was calculated as difference between follow-up and baseline MEEi. Results: In the whole group a significant decrease in Blood Pressure (from 147/91mmHg to 132/81 mmHg p=0.0001) was observed, while body mass index (BMI) was increased (p=0.05) during FU. A decrease in LV mass index was observed (from 46.0 ± 16.7 to 36.9 ± 8.6 g/m2.7, p < 0.001), without significant changes in relative wall thickness (RWT). A decrease in left atrial volume was also observed, while E/e’ did not change. Midwall fractional shortening was reduced, while MEEi did not change (from 0.453 ± 0.15 to 0.445 ± 0.16 mL/s/g, ns from baseline to FU). A significant correlation was observed between changes in MEEi and changes in LVMi; patients with higher improvement in MEEi (>0.07 mL/s/g) had a higher LVMi at baseline and a greater decrease of LVMi and of RWT, in addition to greater reduction in HR and lower values of total cholesterol and LDL cholesterol at FU. No differences were observed between medically or surgically treated patients. Conclusions: In both medical and surgical treatment groups a reduction in LVH was observed. The improvement in MEEi seems to be related to a decrease in LVH, independently of medical or surgical treatment.