Key result
Modified IVC lateralized index yields ~0.92 AUC for right adenoma localization when conventional sampling is difficult.
Why the study?
Catheterization of the right adrenal vein for blood sampling during adrenal venous sampling is often difficult.
Does blood sampling from the IVC at its juncture with the right adrenal vein provide comparable diagnostic performance to direct right adrenal vein sampling in patients with primary aldosteronism?
Observational (n=44)
No
Does blood sampling from the IVC at its juncture with the right adrenal vein provide comparable diagnostic performance to direct right adrenal vein sampling in patients with primary aldosteronism?
Effect estimate: AUC 0.92 for right APA
Absolute Event Rate: 0.92% vs 0.9%
Blood sampling from the IVC at its juncture with the right adrenal vein provides a viable alternative for calculating the lateralized index when direct right adrenal vein sampling is difficult.
May support IVC sampling as alternative in difficult right AVS; hypothesis-generating and requires prospective validation before practice change.
PurposeCatheterization of the right adrenal vein (rt.AdV) to obtain blood samples can often be difficult. The aim of the present study was to investigate whether blood sampling from the inferior vena cava (IVC) at its juncture with the rt.AdV can be an alternative to sampling of blood directly from the rt.AdV.Materials and MethodsThis study included 44 patients diagnosed with primary aldosteronism (PA) in whom AVS with adrenocorticotropic hormone (ACTH) was performed, resulting in a diagnosis of idiopathic hyperaldosteronism (IHA) (n=24), and patients diagnosed with unilateral aldosterone-producing adenoma (APA) (n=20; rt.APA=8, lt.APA=12). In addition to regular blood sampling, blood was also sampled from the IVC, as the substitute rt.AdV [S-rt.AdV]. Diagnostic performance with the conventional lateralized index (LI) and the modified LI using the S-rt.AdV was compared to examine the utility of the modified LI.ResultsThe modified LI of the rt.APA (0.4±0.4) was significantly lower than those of the IHA (1.4±0.7) (p<0.001) and the lt.APA (3.5±2.0) (p<0.001). The modified LI of the lt.APA was significantly higher than those of the IHA (p<0.001) and rt.APA (p<0.001). Sensitivity and specificity to diagnose rt.APA and lt.APA using the modified LI with threshold values of 0.7 and 2.2, respectively, they were 87% and 75%, respectively, and 94% and 94%, respectively.ConclusionThe modified LI has the potential to be an alternative method for rt.AdV sampling in cases in which rt.AdV sampling is difficult. Obtaining the modified LI is extremely simple, which might complement conventional AVS.
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Yamamoto et al. (2022) conducted an observational in Primary aldosteronism (n=44). Modified lateralized index (blood sampling from IVC at juncture with right adrenal vein) vs. Conventional lateralized index (blood sampling directly from right adrenal vein) was evaluated on Diagnostic performance (Area under the ROC curve) for localizing aldosterone-producing adenoma (AUC 0.92 for right APA). The modified lateralized index using blood from the inferior vena cava demonstrated high diagnostic accuracy (AUC 0.92 for right adenoma), serving as a potential alternative when right adrenal vein sampling is difficult.
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