IMPROVEMENT OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION AFTER TREATMENT FOR PRIMARY ALDOSTERONISM CORRELATES WITH REVERSAL OF RENIN SUPPRESSION

Abstract

Objective: Primary aldosteronism (PA) leads to hypertension, left ventricular hypertrophy and systolic dysfunction. While treatment can lead to regression of left ventricular mass, improvement of left ventricular function has not been demonstrated, using the conventional left ventricular ejection fraction for assessment. We used speckle-tracking echocardiography to assess if treatment of PA can improve left ventricular subclinical systolic dysfunction. Design and method: We prospectively recruited 57 patients with PA. All patients underwent 24–hours ambulatory blood pressure (BP) measurements and 2D echocardiography, including global longitudinal strain (GLS), at baseline and 12 months after surgical or medical therapy. Results: Forty–eight of 57 patients underwent adrenal vein sampling, and all procedures were successful. Twenty–five patients underwent unilateral adrenalectomy, and 32 patients were treated with medications. Patients treated with surgery had improved daytime systolic and diastolic BP, with reduced antihypertensive medications, while patients on medications had improved daytime systolic BP, with increased medications. While left ventricular ejection fraction did not change in either group post-treatment, GLS improved post–adrenalectomy by –2.3, 95%CI: –3.9 to –0.6, P = 0.0095, and post–medications by –1.3, 95%CI: –2.6 to 0.03, P = 0.089. On multivariate analysis, baseline GLS was associated with baseline diastolic BP (P = 0.019). Post–adrenalectomy, there were also improvements in left ventricular mass index by –10, 95% CI: –18.0 to –2.4, P = 0.012 left atrial volume index by –5.0, 95%CI: –9.1 to –2.2, P = 0.0016 and mitral E/e’ –1.9, 95%CI: –4.1 to –0.5, P = 0.0064, which were not significant in patients treated medically. Improvement in GLS was independently correlated with baseline GLS (P = 0.0001), and increase in plasma renin activity (P = 0.0068). Conclusions: Treatment of hyperaldosteronism can effectively reverse left ventricular systolic dysfunction, with greater benefit seen with surgery compared to medications. Greater improvement of systolic function is associated with increase in renin levels. This underlies the importance of adequate treatment to reverse the sodium overload state, that is the hallmark of PA.