Why the study?
Primary aldosteronism may cause myocardial injury, prompting investigation into myocardial dysfunction using speckle-tracking echocardiographic layer-specific strain.
Does primary aldosteronism cause subclinical left ventricular dysfunction measured by layer-specific strain compared to primary hypertension?
Does primary aldosteronism cause subclinical left ventricular dysfunction measured by layer-specific strain compared to primary hypertension?
Patients with primary aldosteronism, particularly those with aldosterone-producing adenomas, exhibit impaired regional systolic function and myocardial deformation compared to patients with primary hypertension.
Impaired endocardial strain in primary aldosteronism signals possible subclinical LV dysfunction; hypothesis-generating for aldosterone effects, prospective studies needed.
BACKGROUND: Primary aldosteronism (PA) may cause myocardial injury. We investigated myocardial dysfunction using speckle-tracking echocardiographic (STE) layer-specific strain in patients with PA. METHODS: Our study included 62 patients with PA (33 aldosterone-producing adenoma [APA] and 29 idiopathic hyperaldosteronism [IHA]) and 30 patients with primary hypertension. STE was acquired using the GE Vivid E9 equipment. The longitudinal (LS) and circumferential (CS) layer-specific strains of the endocardium, midmyocardium, and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid, and CSepi) were obtained using the EchoPAC BT13 workstation. RESULTS: Patients with APA, compared with those with primary hypertension and IHA, had a significantly (P < 0.001) lower serum potassium concentration and plasma renin activity, and higher 24-h urinary aldosterone, plasma aldosterone concentration, and aldosterone-to-renin ratio. Left ventricular ejection fraction was normal in all patients (58-60%). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all 3 groups (P < 0.01). However, LSendo and CSendo were lowest in APA (-20.2 ± 2.3% and -33.3 ± 3.2%), intermediate in IHA (-22.1 ± 1.9% and -35.7 ± 2.8%) and highest in primary hypertension (-24.1 ± 2.1% and -38.9 ± 3.1%, P < 0.001). Similar trends were observed for LSmid, LSepi, CSmid, and CSepi, but statistical significance was only reached for the comparison between APA and primary hypertension (P < 0.001), but not others (P > 0.05). Layer-specific strain was significantly correlated with plasma aldosterone concentration for all echocardiographic parameters (r = -0.69 to -0.53, P < 0.001) in all 3 groups. CONCLUSIONS: Patients with PA, especially APA, had impaired regional systolic function with myocardial deformation changes at similar levels of blood pressure, probably because of elevated plasma aldosterone concentration.
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Wang et al. (2018) studied this question.
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