U-006 REVERSAL OF MYOCARDIAL FIBROSIS AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH ALDOSTERONE PRODUCING ADENOMA RECEIVING ADRENALECTOMY

Abstract

Background Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent left ventricular hypertrophy, increased myocardial fibrosis and diastolic dysfunction. Aldosterone producing adenoma (APA) can be cured by adrenalectomy. However, the reversibility of cardiac structure and function still unclear. Method We prospectively analyzed 17 patients withAPA that received adrenalectomy from October 2006 to Oct 2008and 11 patients with essential hypertension (EH) were enrolled as the control group. Echocardiography included including tissue Doppler image (TDI) and ultrasonic tissue characterization by cyclic variation of integrated backscatter (CVIBS) were performed in both groups and one year after operation in unilateral hyperaldosteronism group. Besides, markers of cardiac tissue collagen turnover, including plasma carboxy-terminal propeptide of procollagen type I (PICP) and matrix metalloproteinase-2 (MMP-2) were also checked. Results Patients with APA had significantly higher diastolic blood pressure, higher plasma aldosterone concentration, lower serum potassium level, and lower plasma renin activity (PRA) than patients with EH. In echocardiography, patients with APA had higher left ventricular mass index (LVMI) than EH patients. In the TDI study, APA patients had lower early diastolic velocity (e’) than EH (6.7 ± 1.2 vs.8.9 ± 1.7, p = 0.003 in septal mitral annulus and 7.8 ± 3.0 vs.11.2 ± 2.7, p < 0.001 in lateral mitral annulus). In cardiac tissue character analysis, APA patients had significant lower CVIBS than EH patients (6.7 ± 1.9 vs.9.1 ± 1.7 dB, p = 0.003). In collagen turnover markers, APA patientshad higher plasma PICP, but not MMP-2 than EH patients (PICP: 105 ± 26 vs. 81 ± 28 μg/L, p = 0.03, MMP-2: 223 ± 90 245 ± 63 ng/ml, p = 0.462). One year after adrenalectomy, LVMI decreased significantly. In addition, early diastolic velocity(e’) in TDI study and CVIBS increased significantly after adrenalectomy (p = 0.001 for septal e’; p = 0.012 for lateral e’; p = 0.019 for CVIBS). Plasma PICP also decreases significantly (p = 0.030) after operation. Conclusion Adrenalectomy reverses not only left ventricular geometry but also altered myocardial texture and improve cardiac diastolic function in APA patients. This implies that increases in collagen content in the myocardium of APA patients may be reversed by adrenalectomy.