Abstract
Objectives: to evaluate the structural and functional LV outcome of surgically or medically treated patients with documented primary aldosteronism (PA). Methods: after a cross-sectional Doppler echocardiography assessment of LV wall thickness and dimensions and transmitral LV filling flow velocity indexes, 55 PA patients entered a prospective follow-up study lasting 6.4 years (range: 4.5 to 8 years) after adrenalectomy (n=41) or medical treatment (n=14). The diagnosis of aldosterone producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) was based on adrenal vein sampling, pathology, and on follow-up data. Results: by the PAPY Study criteria 47 patients had APA and 8 IHA. Excess LV hypertrophy (LVH) and concentric remodelling rate was observed at baseline in both groups; atrial contribution to LF filling (ACLVF) was higher in the 14 (6 APA and 8 IHA) medically treated than in the 41 adrenalectomized patients. At follow-up blood pressure (p<0.001) and the rate of LVH decreased (p<0.001): LV mass index (MI) fell (from 115±22 to 106±18 in adrenalectomized patients and from, 118±26 to 103±21 in medically treated patients). This LVMI reduction and an increase of relative wall thickness (from 0.43±0.07 to 0.46±0.06 in adrenalectomized patients and from 0.41±0.06 to 0.45±0.05 in medically treated patients) attained statistical significance only in the former. By contrast, the reduction of ACLVF was significant only in the latter (p=0.002), thus indicating a normalization of the LV diastolic filling indexes (but only in the medically-treated patients which showed an impaired diastolic function at baseline). Conclusion: 1) Both treatments reduce BP, LV mass index and the prevalence of LVH; 2) With a similar fall of blood pressure and despite a greater reduction of antihypertensive drugs, these changes were more prominent in adrenalectomized patients; 3) An improvement of LV diastolic filling occurs also in the medically-treated PA patients when it is altered at baseline.
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