Cardiac Remodeling in Patients With Primary and Secondary Aldosteronism: A Tissue Doppler Study.
BACKGROUND
Primary aldosteronism (PA) causes excess left ventricular (LV) hypertrophy and diastolic dysfunction; whether this occurs also in secondary aldosteronism (SA) without hypertension is unknown. We investigated the cardiac modifications in patients with preserved LV ejection fraction who had PA or SA.


RESULTS
We measured several Doppler echocardiography-derived variables, including tissue Doppler imaging (TDI) parameters and strain rate analysis, in 262 patients with PA, 117 with SA because of liver cirrhosis, and in 61 control healthy subjects. SA and PA patients showed markedly elevated aldosterone levels (67 versus 39 ng/dL, respectively; normal values <15 ng/dL) but contrasting values of plasma renin activity (15.00 versus 0.56 ng/mL/h; P<0.001). Compared with PA, SA patients showed higher heart rate, and lower blood pressure and vascular resistance values. Both PA and SA showed increased LV diameters, LV volumes, stroke volume, stroke work, and septal peak systolic tissue velocity, and had more LV hypertrophy (61% and 39%, respectively) and diastolic dysfunction (35% and 36%, respectively) than healthy subjects. Peak systolic septal strain (20% versus 23%; P=<0.001) and midwall fractional shortening (15.9% versus 16.7%; P=0.001) were lower in PA than in SA patients.


CONCLUSIONS
Primary and secondary hyperaldosteronism correlate with LV enlargement and high prevalence of LV hypertrophy and diastolic dysfunction; a subclinical systolic dysfunction is evident only in PA. In SA, the high rate of LV hypertrophy, in spite of low peripheral resistances and low-to-normal blood pressure, could be accounted for the high renin and aldosterone values, and the work overload associated with a hyperdynamic circulatory state.
From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.).
Maurizio
M
Cesari
From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.).
Claudio
C
Letizia
From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.).
Paolo
P
Angeli
From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.).
Susanna
S
Sciomer
From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.).
Silvia
S
Rosi
From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.). gianpaolo.rossi@unipd.it.
Gian Paolo
GP
Rossi
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D001794:Blood Pressure; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D015995:Prevalence; D012083:Renin / Q000097:blood; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D015415:Biomarkers; D000450:Aldosterone; D012083:Renin
aldosterone; cirrhosis; diastolic dysfunction echocardiography; echocardiography; hypertrophy; left ventricular systolic function; strain rate imaging