SAT-540 Primary Aldosteronism Represents Earlier Myocardial Fibrosis Than Essential Hypertension by T1 Mapping

Abstract

Introduction:Primary aldosteronism (PA) is associated with cardiovascular disease and has increased cardiovascular morbidity. Several studies had demonstrated that PA shows more serious myocardial fibrosis compared with essential hypertension (EH) using late Gadolinium-enhanced (LGE) imaging [1, 2]. However, the early myocardial change may not be detected by LGE. Recently, cardiac MRI T1 mapping emerged to be a sensitive technique in detecting early changes of myocardium quantitatively. Our study aimed to demonstrate the early myocardial change in PA patients by applying the T1-mapping technique.Method:81 (male: 25; age: 48±12 years) PA[3] and 44 (male: 21; age: 47±14 years) EH patients diagnosed by the Department of Endocrinology and metabolism according to the 2016 TES guidelines for PA were recruited from September 2018 to May 2019. All the subjects underwent cardiac MRI examinations on a 3T MRI scanner (MAGNETOM Trio a Tim System, Siemens Healthcare, Erlangen, Germany), including steady-state free-precession (SSFP) cine imaging and modified Look-Locker inversion recovery (MOLLI) imaging for T1 mapping. Functional parameters were obtained from cine images by the Argus software (Siemens Healthcare, Erlangen, Germany).The mid-ventricular native T1 value was acquired using the QMass software (Medis, Leiden, The Netherlands). Native T1 value and cardiac function parameters were analyzed between the two groups. Differences of continuous variables were analyzed by Student’s t-test or Mann-Whitney U-test, and the relationships between native T1 value and physiological variables were analyzed by multiple linear regression method.Results:The age (PA: 48±12 years vs EH: 47±14 years; p=0.720) and BMI (PA: 25.06±3.73 vs EH: 25.17±2.83; P=0.874) between two groups had no significant differences. The PA group had a significant higher aldosterone/renin ratio (ARR) than those in the EH group (114.6 (48.7-474.8)ng/dl:ng/ml.h vs 7.6 (4.2-13.8) ng/dl:ng/ml.h; p<0.001). All functional parameters including LVEDVI (PA: 78.66 (72.4-90.6) ml/m2 vs EH: 75.8 (64.3-85.8) ml/m2; p=0.054); LVESVI (PA: 31.7 (26.2-38.4) ml/m2 vs EH: 29.3 (24.9-36.2) ml/m2; p=0.152); LVEF (PA: 59.9 (53.3-65.0)% VS EH: 59.2(55.3-65.6)%; p=0.679); LVmassi (PA: 58.5(47.7-67.7) g/m2 vs EH: 54.9 (47.6-60.1) g/m2; p=0.463) had no differences between the two groups. However, native T1 values were higher in PA group than those in EH group (1227±40ms vs 1203±45ms). The multiple linear regression analysis showed that gender (Beta=-27.678, p<0.001) and PA (Beta=-17.287, p=0.031) were independently related to the native T1 values.Conclusion:PA patients represent more severe and earlier myocardium damage and this might be related to cardiovascular morbidity. The T1-mapping technique in cardiac MRI is more sensitive to evaluate the left ventricular function and to detect the myocardial fibrosis in PA patients.