Adrenalectomy reverses myocardial fibrosis in patients with primary aldosteronism.
OBJECTIVE
Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with more prominent left ventricular hypertrophy and increased myocardial fibrosis. However, the reversibility of cardiac fibrosis is still unclear. Our objective was to investigate myocardial fibrosis in primary aldosteronism patients and its change after surgery.


METHODS
We prospectively analyzed 20 patients with aldosterone-producing adenoma (APA) who received adrenalectomy from December 2006 to October 2008 and 20 patients with essential hypertension were enrolled as the control group. Plasma carboxy-terminal propeptide of procollagen type I (PICP) determination and echocardiography including ultrasonic tissue characterization by cyclic variation of integrated backscatter (CVIBS) were performed in both groups and 1 year after operation in the APA group.


RESULTS
APA patients had significantly higher SBP and DBP, higher plasma aldosterone concentration (PAC), higher aldosterone-renin ratio (ARR), lower serum potassium levels, and lower plasma renin activity (PRA) than patients with essential hypertension. In echocardiography, APA patients had a higher left ventricular mass index than essential hypertension patients. APA patients had significantly lower CVIBS (6.2 ± 1.5 vs. 8.7 ± 2.0 dB, P < 0.001) and higher plasma PICP levels (107 ± 27 vs. 85 ± 24 μg/l, P = 0.009) than essential hypertension patients. In the correlation study, CVIBS is correlated with log-transformed PRA and log-transformed ARR and PICP is correlated with log-transformed PRA, log-transformed PAC, and log-transformed ARR. One year after adrenalectomy, CVIBS increased significantly (6.2 ± 1.5 to 7.3 ± 1.7 dB, P = 0.033) and plasma PICP levels decreased (107 ± 27 vs. 84 ± 28 μg/l, P = 0.026).


CONCLUSIONS
Increases in collagen content in the myocardium of APA patients may be reversed by adrenalectomy.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Yen-Hung
YH
Lin
Xue-Ming
XM
Wu
Hsiu-Hao
HH
Lee
Jen-Kuang
JK
Lee
Yu-Chun
YC
Liu
Hung-Wei
HW
Chang
Chien-Yu
CY
Lin
Vin-Cent
VC
Wu
Shih-Chieh
SC
Chueh
Lung-Chun
LC
Lin
Men-Tzung
MT
Lo
Yi-Lwun
YL
Ho
Kwan-Dun
KD
Wu
D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D000450:Aldosterone / Q000097:blood; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004452:Echocardiography; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006973:Hypertension / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010446:Peptide Fragments; D011188:Potassium / Q000097:blood; D011347:Procollagen; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D016896:Treatment Outcome
D010446:Peptide Fragments; D011347:Procollagen; C042813:procollagen type I carboxy terminal peptide; D000450:Aldosterone; D012083:Renin; D011188:Potassium