Key result
24-hour urinary aldosterone better predicts LVH and inappropriate LVMI than plasma aldosterone or aldosterone-to-renin ratio.
Why the study?
There is no ideal parameter to predict the presence of left ventricular hypertrophy or inappropriate LV mass index in patients with primary aldosteronism.
Does 24-hour urinary aldosterone level better predict the presence of LVH and inappropriate LVMI compared to plasma aldosterone and renin parameters in patients with primary aldosteronism?
Cross-Sectional (n=137)
No
Does 24-hour urinary aldosterone level better predict the presence of LVH and inappropriate LVMI compared to plasma aldosterone and renin parameters in patients with primary aldosteronism?
Effect estimate: ROC AUC 0.701 for LVH; ROC AUC 0.61 for inappropriate LVMI
24-hour urinary aldosterone is a better predictor of left ventricular hypertrophy and inappropriate left ventricular mass index than plasma aldosterone or renin parameters in patients with primary aldosteronism.
24h urinary aldosterone may aid LVH stratification in PA; leaves open incremental value over plasma measures in prospective studies.
OBJECTIVE: Primary aldosteronism (PA) is associated with inappropriate left ventricular hypertrophy (LVH) in relation to a given gender and body size. There is no ideal parameter to predict the presence of LVH or inappropriate LVH in patients with PA. We investigate the performance of 24-hour urinary aldosterone level, plasma renin activity and aldosterone-to-renin ratio on this task. METHODS: We performed echocardiography in 106 patients with PA and 31 subjects with essential hypertension (EH) in a tertiary teaching hospital. Plasma renin activity, aldosterone concentration, and 24-hour urinary aldosterone level were measured. RESULTS: Only 24-hour urinary aldosterone was correlated with left ventricular mass index (LVMI) and excess LVMI among these parameters. The multivariate analysis revealed the urinary aldosterone level as an independent predictor for LVMI and excess LVMI. Analyzing the ability of urinary aldosterone, plasma aldosterone concentration, and plasma aldosterone-to-renin ratio to identify the presence of LVH (ROC AUC = 0.701, 0.568, 0.656, resp.) and the presence of inappropriate LV mass index (defined as measured LVMI in predicting LVMI ratio >135%) (ROC area under curve = 0.61, 0.43, 0.493, resp.) revealed the better performance of 24-hour urinary aldosterone. CONCLUSIONS: In conclusion, 24-hour urinary aldosterone level performed better to predict the presence of LVH and inappropriate LVMI in patients with PA.
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Hung et al. (2013) conducted a cross-sectional in Primary aldosteronism (n=137). 24-hour urinary aldosterone level vs. Plasma aldosterone concentration and aldosterone-to-renin ratio was evaluated on Presence of left ventricular hypertrophy (LVH) and inappropriate LV mass index (ROC AUC 0.701 for LVH; ROC AUC 0.61 for inappropriate LVMI). 24-hour urinary aldosterone level was a better predictor of left ventricular hypertrophy (AUC 0.701) and inappropriate LV mass index (AUC 0.61) than plasma aldosterone or aldosterone-to-renin ratio.
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