Why the study?
Although guidelines recommend surgery and drug treatment for primary aldosteronism, their effects on cardiac structure and function remain under investigation.
Does surgical removal of an adrenal gland improve cardiac structure and function compared to mineralocorticoid antagonist treatment in patients with primary aldosteronism?
Does surgical removal of an adrenal gland improve cardiac structure and function compared to mineralocorticoid antagonist treatment in patients with primary aldosteronism?
Surgical removal of an adrenal gland, but not mineralocorticoid receptor antagonism, provides early improvement in cardiac function in patients with primary aldosteronism despite similar blood pressure and potassium control.
Answers are grounded in this paper and cite their sources.
Surgery may confer greater early cardiac functional benefit than mineralocorticoid antagonism despite similar BP control; leaves open confirmation in randomized trials.
Background Current guideline recommends both surgery and drug treatment for primary aldosteronism. Treatment effects on the cardiac structure and function remain under investigation. Objective We performed a prospective study in patients with primary aldosteronism to compare effects of surgery and drug treatment on the cardiac structure and function as assessed by the left ventricular (LV) pressure-strain loop, a novel echocardiographic technique that incorporates myocardial deformation and LV pressure. Methods Our study included 39 and 28 patients treated with surgery and a mineralocorticoid antagonist, respectively. We performed conventional and speckle tracking echocardiography at baseline and 3 and 6 months of follow-up. Results During follow-up, both surgery and drug treatment normalized serum potassium concentration and significantly reduced blood pressure. Both treatments significantly and similarly decreased LV mass index and left atrial volume index. However, only in the surgery group did global wasted work significantly decrease (200.8 ± 86.7 at baseline vs. 142.1 ± 58.1 mmHg% at 6 months) and global work efficiency (91.5 ± 3.1 vs . 93.6 ± 2.3%) and global longitudinal strain (−18.3 ± 2.7 vs . −19.2 ± 1.9%) significantly ( p < 0.01) increase at 6 months of follow-up. The corresponding differences from the changes in the drug treatment group were 39.5 mmHg% (95% CI, 17.1, 62.0 mmHg%), −1.64% (95% CI, −2.56, −0.71%), and −0.85% (95% CI, −1.51, −0.20%), respectively. In addition, the changes in global wasted work at 6 months of follow-up was significantly correlated with that in 24-h urinary aldosterone excretion in the drug treatment group ( r = 0.54) and two groups combined ( r = 0.55), but not the surgery group. Conclusion In spite of similar serum potassium normalization and blood pressure control, surgical removal of an adrenal gland, but not mineralocorticoid receptor antagonism, showed early improvement in cardiac function.
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Chen et al. (2021) studied this question.
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