A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism

BackgroundCurrent guideline recommends both surgery and drug treatment for primary aldosteronism. Treatment effects on the cardiac structure and function remain under investigation.ObjectiveWe performed a prospective study in patients with primary aldosteronism to compare effects of surgery and drug treatment on the cardiac structure and function as assessed by the left ventricular (LV) pressure-strain loop, a novel echocardiographic technique that incorporates myocardial deformation and LV pressure.MethodsOur study included 39 and 28 patients treated with surgery and a mineralocorticoid antagonist, respectively. We performed conventional and speckle tracking echocardiography at baseline and 3 and 6 months of follow-up.ResultsDuring follow-up, both surgery and drug treatment normalized serum potassium concentration and significantly reduced blood pressure. Both treatments significantly and similarly decreased LV mass index and left atrial volume index. However, only in the surgery group did global wasted work significantly decrease (200.8 ± 86.7 at baseline vs. 142.1 ± 58.1 mmHg% at 6 months) and global work efficiency (91.5 ± 3.1 vs. 93.6 ± 2.3%) and global longitudinal strain (−18.3 ± 2.7 vs. −19.2 ± 1.9%) significantly (p < 0.01) increase at 6 months of follow-up. The corresponding differences from the changes in the drug treatment group were 39.5 mmHg% (95% CI, 17.1, 62.0 mmHg%), −1.64% (95% CI, −2.56, −0.71%), and −0.85% (95% CI, −1.51, −0.20%), respectively. In addition, the changes in global wasted work at 6 months of follow-up was significantly correlated with that in 24-h urinary aldosterone excretion in the drug treatment group (r = 0.54) and two groups combined (r = 0.55), but not the surgery group.ConclusionIn spite of similar serum potassium normalization and blood pressure control, surgical removal of an adrenal gland, but not mineralocorticoid receptor antagonism, showed early improvement in cardiac function.

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Abstract 068: Hypertension And Longitudinal Changes In Cardiac Structure And Function In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study

Circulation ◽

10.1161/circ.143.suppl_1.068 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jennifer McLeod ◽

Barry E Hurwitz ◽

Daniela Sotres-Alvarez ◽

Mayank M Kansal ◽

Katrina Swett ◽

...

Keyword(s):

Blood Pressure ◽

Structure And Function ◽

Longitudinal Change ◽

Longitudinal Impact ◽

Cardiac Structure ◽

Linear Regression Models ◽

End Diastolic Volume ◽

Cardiac Structure And Function ◽

And Function

Introduction: Hypertension, one of the most modifiable risk factors of heart disease, induces cardiac remodeling and worsens myocardial function prior to the development of clinical symptoms. Using a comprehensive cohort of Hispanic/Latino adults, we assessed cardiac structure and function, in relation to hypertension, and the longitudinal impact of blood pressure control. Hypothesis: If baseline hypertensive adults are stratified by longitudinal blood pressure (BP) control, there will be differences in the progression of cardiac structure and function parameters. Methods: The Echo-SOL Ancillary Study provided serial comprehensive echocardiographic assessments of Hispanic adults aged 45-74 years. They were arranged into two groups based on the presence of baseline hypertension (>140/90mmHg). Linear regression models were used to estimate the association between baseline BP properties and the longitudinal change in echocardiogram parameters. We then subdivided each group based on whether the they maintained BP control (<140/90mmHg) on follow up and used linear regression models to test for significance among the mean longitudinal change of echocardiogram parameters. All analyses accounted for the complex sampling design of HCHS/SOL and Echo-SOL. Results: There was a total of 1818 adults at baseline, with 1643 obtaining serial echocardiograms an average of 4.3 years later, mean age of approximately 56 years. Among all adults, baseline pulse pressure was significantly associated with a longitudinal increase in left ventricular (LV) end diastolic volume (β=0.13, p=0.02), whereas the change in LV mass index longitudinally decreased with baseline diastolic BP (β=-0.14, p<0.01). When isolating the subgroup defined as hypertensive at baseline, the adults who had uncontrolled BP on follow up had a greater absolute increase in the average E/E’ ratio and greater decrease in average E’ velocity, 0.95±0.08 and -0.96±0.06 respectively, compared to the adults with controlled BP 0.04±0.07 and -0.74± 0.04 respectively (p<0.01). In addition, the controlled BP group had a greater absolute reduction in LV end-diastolic volume of 6.94mL than those with uncontrolled BP, 4.60mL (p<0.01). Conclusions: Our study is the first to study the association of longitudinal impact of blood pressure control with cardiac structure and function in Hispanic/Latino adults. We found that higher baseline brachial BP properties were associated with reduced in LV mass index and increased LV end diastolic volumes. Among the baseline hypertensive adults, there was a significantly higher progression in diastolic dysfunction among the participants who had poor BP control, but those with controlled BP on follow up had greater LV enlargement. Despite these differences, both subgroups ultimately showed a collective progression in diastolic dysfunction and a decrease in end-diastolic volume over time.

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