Remodeling of the left ventricle in primary aldosteronism due to Conn's adenoma.
BACKGROUND
Since hyperaldosteronism has been experimentally related to myocardial interstitial fibrosis, we investigated the effects of hypertension and excess aldosterone due to aldosterone-producing adenomas (APAs) on the heart.


RESULTS
In 52 hypertensive individuals, we performed Doppler echocardiography for estimation of left ventricular (LV) wall thickness and dimensions, transmitral LV filling flow velocity indexes, and 24-hour ambulatory blood pressure monitoring. Consecutive patients with APAs (n = 26) and essential hypertension (EH, n = 26) were individually matched for age, sex, race, body mass index, casual blood pressure, and known duration of hypertension. The matched groups were similar for demography, casual and 24-hour blood pressure values and variability, and duration of hypertension but differed for serum potassium, plasma renin activity, and aldosterone levels (all P < .001). A thicker interventricular septum (P = .015) and posterior wall (P = .009) and a higher LV mass index (118 +/- 5 versus 100 +/- 4 g/m2, P = .009) were observed in APA compared with EH patients. Both septum and posterior wall thicknesses had a significant direct relationship with age, plasma aldosterone, and mean blood pressure. The integral of the early diastolic filling wave (Ei) (P = .011) and the ratio Ei/Ai (A wave integral) (P = .038) were lower and the atrial contribution to LV filling was higher (52 +/- 2% versus 46 +/- 2%, P = .038) in APA than in EH patients. The ratio Ei/Ai was significantly (P = .008) inversely related only to age and plasma aldosterone.


CONCLUSIONS
In APA patients, the excess aldosterone is associated with both increased LV wall thickness and mass and decreased early diastolic LV filling indexes compared with demographically similar EH with superimposable blood pressure values, profile, and variability.
Rossi
G P
GP
Department of Clinical and Experimental Medicine, University of Padua Medical School, Italy. gprossi@ipdunidx.unipd.it
Sacchetto
A
A
Pavan
E
E
Palatini
P
P
Graniero
G R
GR
Canali
C
C
Pessina
A C
AC
D000236:Adenoma / Q000150:complications* / Q000378:metabolism*; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left
D000450:Aldosterone