Left Ventricular Dysfunction in Patients With Primary Aldosteronism: A Propensity Score–Matching Follow‐Up Study With Tissue Doppler Imaging

Author:

Chang Yi‐Yao1234,Liao Che‐Wei5,Tsai Cheng‐Hsuan3,Chen Ching‐Way6,Pan Chien‐Ting3,Chen Zheng‐Wei6,Chen Ya‐Li3,Lin Lung‐Chun3,Chang Yi‐Ru3,Wu Vin‐Cent3,Wu Kwan‐Dun3,Hung Chi‐Sheng3,Lin Yen‐Hung3,Wu Che‐Hsiung,Chang Hung‐Wei,MD Lian‐Yu Lin,Hu Fu‐Chang,Liu Kao‐Lang,Wang Shuo‐Meng,Huang Kuo‐How,Chen Yung‐Ming,Chang Chin‐Chen,Liao Shih‐Cheng,Yen Ruoh‐Fang

Affiliation:

1. Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan

2. Cardiology Division of Cardiovascular Medical Center Far Eastern Memorial Hospital New Taipei City Taiwan

3. Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan

4. Center of General Education Chihlee University of Technology New Taipei City Taiwan

5. Department of Internal Medicine National Taiwan University Hospital Hsin‐Chu Branch Hsin‐Chu Taiwan

6. Department of Internal Medicine National Taiwan University Hospital Yun‐Lin Branch Yun‐Lin Taiwan

Abstract

Background Primary aldosteronism is the most common cause of secondary hypertension and is associated with left ventricular hypertrophy. However, whether aldosterone excess is responsible for left ventricular (LV) diastolic dysfunction is unknown. Methods and Results We prospectively enrolled 129 patients with aldosterone‐producing adenoma and 120 patients with essential hypertension, and analyzed their clinical, biochemical, and echocardiographic data, including tissue Doppler images. The patients with aldosterone‐producing adenoma were reevaluated 1 year after adrenalectomy. After propensity score matching, there were 105 patients in each group. The patients with aldosterone‐producing adenoma had worse diastolic function than the patients with essential hypertension, as reflected by lower e′ ( P <0.001) and higher E/e′ ( P =0.003). Multivariate analysis showed that LV diastolic function was significantly correlated with age ( P <0.001), sex ( P <0.001), body mass index ( P =0.002), systolic blood pressure ( P =0.004), creatinine ( P =0.008), and log‐transformed aldosterone‐renin ratio ( P =0.003). After adrenalectomy, the patients with aldosterone‐producing adenoma had significant improvements in LV diastolic function as reflected by an increase in e′ ( P =0.003) and decrease in E/e′ ( P =0.002). The change in E/e′ was independently correlated with baseline E/e′ ( P <0.001) and change in LV mass index ( P =0.006). Conclusions The patients with primary aldosteronism had worse LV diastolic function than the patients with essential hypertension after propensity score matching, and this could be reversed after adrenalectomy, suggesting that aldosterone excess may induce LV diastolic dysfunction.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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