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...

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Autores principales:	Yi-Lin Chen, Ting-Yan Xu, Jian-Zhong Xu, Li-Min Zhu, Yan Li, Ji-Guang Wang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	primary aldosteronism adrenalectomy mineralocorticoid receptor antagonist left ventricular pressure-strain loop left ventricular mass index left atrial volume index Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/08ef51a31c864dc8992ae6dcc0456e8c
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spelling	oai:doaj.org-article:08ef51a31c864dc8992ae6dcc0456e8c2021-11-11T13:29:26ZA Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism1664-239210.3389/fendo.2021.770711https://doaj.org/article/08ef51a31c864dc8992ae6dcc0456e8c2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.770711/fullhttps://doaj.org/toc/1664-2392BackgroundCurrent 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.Yi-Lin ChenTing-Yan XuJian-Zhong XuLi-Min ZhuYan LiJi-Guang WangFrontiers Media S.A.articleprimary aldosteronismadrenalectomymineralocorticoid receptor antagonistleft ventricular pressure-strain loopleft ventricular mass indexleft atrial volume indexDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	primary aldosteronism adrenalectomy mineralocorticoid receptor antagonist left ventricular pressure-strain loop left ventricular mass index left atrial volume index Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	primary aldosteronism adrenalectomy mineralocorticoid receptor antagonist left ventricular pressure-strain loop left ventricular mass index left atrial volume index Diseases of the endocrine glands. Clinical endocrinology RC648-665 Yi-Lin Chen Ting-Yan Xu Jian-Zhong Xu Li-Min Zhu Yan Li Ji-Guang Wang A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism
description	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.
format	article
author	Yi-Lin Chen Ting-Yan Xu Jian-Zhong Xu Li-Min Zhu Yan Li Ji-Guang Wang
author_facet	Yi-Lin Chen Ting-Yan Xu Jian-Zhong Xu Li-Min Zhu Yan Li Ji-Guang Wang
author_sort	Yi-Lin Chen
title	A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism
title_short	A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism
title_full	A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism
title_fullStr	A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism
title_full_unstemmed	A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism
title_sort	prospective comparative study on cardiac alterations after surgery and drug treatment of primary aldosteronism
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/08ef51a31c864dc8992ae6dcc0456e8c
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A Prospective Comparative Study on Cardiac Alterations After Surgery and Drug Treatment of Primary Aldosteronism

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