Cardiovascular events are more likely to occur in people with primary aldosteronism (PA). The usual assessment using LV ejection fraction (LVEF), however, has not demonstrated that therapy of PA improves left ventricular (LV) systolic function. After PA therapy, researchers wanted to employ speckle-tracking echocardiography to see if there has been an improvement in subclinical systolic function.
They prospectively included 57 PA patients who underwent 24-hour ambulatory blood pressure (BP) monitoring and echocardiogram, which included measuring the left ventricle’s global longitudinal strain (GLS), at the beginning of the study and 12 months after finishing the course of therapy.
In 14 of 50 (28.0%) patients at baseline, the GLS was low. GLS was linked to both glomerular filtration rate (P=0.026) and diastolic blood pressure (P=0.038) on multivariable analysis. LVEF did not alter in either group, but GLS did, with improvements of -2.3, 95% CI: -3.9 to -0.6, P=0.010) and -1.3, 95% CI: -2.6 to 0.03, P=0.089, respectively, post-surgery and post-medication. Both an increase in plasma renin activity (P=0.007)and a reduction in baseline GLS (P<0.001) were independently linked with improvements in GLS. Improvements in GLS were seen in individuals with post-treatment plasma renin activities ≥1 ng/ml/h (P=0.0019), but not in those with continuously suppressed renin. In contrast to patients receiving medication, those who underwent an adrenalectomy also experienced improvements in their LV mass index (P=0.012), left atrial volume index (P=0.002), and mitral E/e’ (P=0.006).
Subclinical LV systolic dysfunction can be improved by treating hyperaldosteronism. Better systolic function follows therapy when renin levels are up, indicating that the salt overload situation has been sufficiently reversed.