AUTHOR=Puar Troy H. , Cheong Chin Kai , Foo Roger S.Y. , Saffari Seyed Ehsan , Tu Tian Ming , Chee Min Ru , Zhang Meifen , Ng Keng Sin , Wong Kang Min , Wong Andrew , Ng Foo Cheong , Aw Tar Choon , Khoo Joan , Gani Linsey , King Thomas , Loh Wann Jia , Soh Shui Boon , Au Vanessa , Tay Tunn Lin , Tan Eberta , Mae Lily , Yew Jielin , Tan Yen Kheng , Tong Khim Leng , Lee Sheldon , Chai Siang Chew 

TITLE=Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.916744

DOI=10.3389/fendo.2022.916744

ISSN=1664-2392

ABSTRACT=Introduction  

Primary aldosteronism (PA) is associated with increased risk of cardiovascular events. However, treatment of PA has not been shown to improve left ventricular systolic function using the conventional assessment with left ventricular ejection fraction (LVEF). We aim to use speckle–tracking echocardiography to assess for improvement in subclinical systolic function after treatment of PA.

Methods 

We prospectively recruited 57 patients with PA, who underwent 24–hour ambulatory blood pressure (BP) measurements and echocardiography, including global longitudinal strain (GLS) assessment of left ventricle, at baseline and 12 months post–treatment. 

Results 

At baseline, GLS was low in 14 of 50 (28.0%) patients. On multivariable analysis, GLS was associated with diastolic BP (P=0.038) and glomerular filtration rate (P=0.026). GLS improved post–surgery by –2.3, 95% CI: –3.9 to –0.6, P=0.010, and post–medications by –1.3, 95% CI: –2.6 to 0.03, P=0.089, while there were no changes in LVEF in either group. Improvement in GLS was independently correlated with baseline GLS (P<0.001) and increase in plasma renin activity (P=0.007). Patients with post–treatment plasma renin activity ≥1ng/ml/hr had improvements in GLS (P=0.0019), while patients with persistently suppressed renin had no improvement. Post–adrenalectomy, there were also improvements in left ventricular mass index (P=0.012), left atrial volume index (P=0.002) and mitral E/e’ (P=0.006), while it was not statistically significant in patients treated with medications.

Conclusion

Treatment of hyperaldosteronism is effective in improving subclinical left ventricular systolic dysfunction. Elevation of renin levels after treatment, which reflects adequate reversal of sodium overload state, is associated with better systolic function after treatment.