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Horm Metab Res 2012; 44(03): 188-193
DOI: 10.1055/s-0032-1301902
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Predictive Factors of Left Ventricular Mass Changes after Treatment of Primary Aldosteronism

C. Catena
1   Internal Medicine, Hypertension Unit, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
,
G. L. Colussi
1   Internal Medicine, Hypertension Unit, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
,
L. Marzano
1   Internal Medicine, Hypertension Unit, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
,
L. A. Sechi
1   Internal Medicine, Hypertension Unit, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
› Author Affiliations
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Publication History

received 22 August 2011

accepted 18 January 2012

Publication Date:
20 February 2012 (online)

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Abstract

A variety of abnormalities that occur in patients with primary aldosteronism indicate the capability of elevated aldosterone to induce cardiac damage over that induced by hypertension itself. This study investigates factors that can predict structural and functional changes of the heart after treatment of primary aldosteronism in a post-hoc analysis of 54 patients who were enrolled in a long-term follow-up study that was conducted after either adrenalectomy or treatment with spironolactone. Cardiac ultrasound assessment was performed before treatment and after with an average follow-up of 6.4 years. During follow-up, blood pressure decreased significantly and comparably in both treatment groups. In both treatment groups, left ventricular mass decreased significantly with a trend to improved diastolic filling profile and no changes in ventricular geometry. At univariate analysis, changes in left ventricular mass induced by treatment of primary aldosteronism were directly related with changes in systolic blood pressure and pretreatment plasma aldosterone levels measured both at baseline and after an intravenous saline load. This relationship was maintained when patients treated with adrenalectomy and spironolactone were analyzed separately. Multivariate regression analysis showed that changes in systolic blood pressure and pretreatment aldosterone levels were independent predictors of left ventricular mass changes after treatment. This study strongly supports a role of aldosterone in promoting left ventricular hypertrophy that is independent of the hypertension-related hemodynamic load and suggests a practical way to predict left ventricular mass changes following surgical and medical treatment of primary aldosteronism.

Key words

adrenalectomy - diastolic function - echocardiography - left ventricular hypertrophy - spironolactone
 

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