title: Myocardial and aortic stiffening in the early course of primary aldosteronism.
abstract: BACKGROUND
  Primary aldosteronism (PA) has been experimentally and clinically linked to myocardial and vascular fibrosis, and it has been further associated with left ventricular (LV) structural adaptations.
  
  
  OBJECTIVE
  Functional cardiovascular adaptations in hypertensive patients with PA precede structural alterations in the early stages of the disease.
  
  
  METHODS
  We studied 17 hypertensive subjects with a recent diagnosis of PA (10 male patients, aged approximately 55 y, with office blood pressure [BP] of 137/88 mm Hg), and 30 essential hypertensives matched for age, sex, office BP levels, treatment status, and LV mass index (LVMI). Apart from standard 2-Dimensional (2-D) and conventional Doppler parameters, tissue Doppler imaging (TDI) methodology was used to assess LV diastolic function; averaging early and late diastolic mitral annular peak velocities (Emav/, Amav, Emav/Amav ratio) from 4 separate sites of measurement (septal, lateral, anterior, and inferior walls). Aortic stiffness was evaluated by means of carotid-femoral pulse wave velocity (cf-PWV) measurements.
  
  
  RESULTS
  Although transmitral E/A ratio was similar in both groups (0.95+/-0.26 versus 0.98+/-0.24, p=0.66), hypertensive subjects with PA compared with essential hypertensives are characterized by significantly higher relative wall thickness (0.50+/-0.07 versus 0.41+/-0.06, p<or=0.001), decreased values of Emav (7+/-1.7 versus 8.1+/-1.8 cm/s, p=0.048), and Emav/Amav ratio (0.63+/-0.16 versus 0.77+/-0.17, p=0.015). The higher PWV in the PA population failed to reach statistical significance (8.5+/-1.6 versus 7.9+/-0.9 msec, p=0.19).
  
  
  CONCLUSIONS
  Our study demonstrates altered LV geometry and TDI-revealed diastolic dysfunction in hypertensives with PA compared with demographically- and LVMI-matched essential hypertensives. Furthermore, the increased aortic stiffening in PA patients failed to reach statistical significance.
authors.affiliation: Department of Cardiology, First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece. ktsioufis@hippocratio.gr
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Dimitriadis
authors.forename: Pavlos
authors.initials: P
authors.lastname: Stougiannos
authors.forename: Platonas
authors.initials: P
authors.lastname: Missovoulos
authors.forename: Apostolis
authors.initials: A
authors.lastname: Kakkavas
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kallikazaros
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
references.citation: J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67
references.pmid: 2698218
references.citation: Am J Cardiol. 1997 Apr 1;79(7):921-8
references.pmid: 9104907
references.citation: Am J Hypertens. 2006 Jan;19(1):13-8
references.pmid: 16461184
references.citation: Hypertension. 2002 Jul;40(1):23-7
references.pmid: 12105133
references.citation: N Engl J Med. 1998 Dec 17;339(25):1828-34
references.pmid: 9854120
references.citation: Curr Opin Cardiol. 2002 Jul;17(4):368-73
references.pmid: 12151871
references.citation: Am Heart J. 1996 May;131(5):982-7
references.pmid: 8615320
references.citation: J Am Coll Cardiol. 2005 Apr 19;45(8):1243-8
references.pmid: 15837256
references.citation: Eur Heart J. 2006 Nov;27(21):2588-605
references.pmid: 17000623
references.citation: Am J Hypertens. 2006 Jan;19(1):10-2
references.pmid: 16461183
references.citation: J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300
references.pmid: 17161262
references.citation: Hypertension. 1996 May;27(5):1039-45
references.pmid: 8621194
references.citation: Am J Hypertens. 2006 Sep;19(9):909-14
references.pmid: 16942932
references.citation: Circulation. 1997 Mar 18;95(6):1471-8
references.pmid: 9118515
references.citation: Am J Hypertens. 2002 Oct;15(10 Pt 1):896-902
references.pmid: 12372677
references.citation: Heart. 2006 May;92(5):712-8
references.pmid: 16614298
references.citation: J Am Coll Cardiol. 2002 Jun 19;39(12):2005-11
references.pmid: 12084601
references.citation: J Hypertens. 2005 Sep;23(9):1745-50
references.pmid: 16093921
references.citation: J Clin Endocrinol Metab. 2005 Sep;90(9):5070-6
references.pmid: 15941863
references.citation: J Hypertens. 2006 May;24(5):965-72
references.pmid: 16612260