title: Clinical impact of strict criteria for selectivity and lateralization in adrenal vein sampling.
abstract: BACKGROUND
  Selectivity index (SI) and lateralization index (LI) thresholds determine the adequacy of adrenal vein sampling (AVS) and the degree of lateralization. The purpose of this study was investigate the clinical outcome of patients whose adrenal vein sampling was interpreted using "strict criteria" (SC) (SIpre-stimuli≥3, SIpost-stimuli≥5 and LIpre-stimuli≥4, LIpost-stimuli≥4).
  
  
  METHODS
  A retrospective review of 73 consecutive AVS procedures was performed and 67 were technically successful. Forty-three patients showed lateralization and underwent surgery, while 24 did not lateralize and were managed conservatively. Systolic blood pressure (SBP), diastolic blood pressure (DBP), kalemia (K(+)), and the change in number of blood pressure (BP) medications were recorded for each patient before and after AVS and potential surgery were performed.
  
  
  RESULTS
  In the surgery group, BP and K(+) changed respectively from 160±5.3/100±2.0 mmHg to 127±3.3/80±1.9 (p <0.001) and from 3.00±0.10 to 4.4±0.09 (p <0.001). In the medically managed group, BP and K(+) changed respectively from 148±7.3/93±4.3 to 135±3.3/86±1.9 (p <0.001) and from 2.68±0.10 to 4.3±0.09. After surgery or AVS, the patients who took ≥3 blood pressure medications were six (14.0%) in the lateralized group and 22 (91.7%) in the non-lateralized group (p <0.001).
  
  
  CONCLUSIONS
  AVS interpretation with SC leads to significant clinical improvement in both patients who underwent surgery and those managed conservatively.
authors.affiliation: University of Virginia, Charlottesville, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gasparetto
authors.affiliation: University of Virginia, Charlottesville, USA. jfa3h@virginia.edu.
authors.forename: John F
authors.initials: JF
authors.lastname: Angle
authors.affiliation: University of Virginia, Charlottesville, USA.
authors.forename: Pasha
authors.initials: P
authors.lastname: Darvishi
authors.affiliation: University of Virginia, Charlottesville, USA.
authors.forename: Colbey W
authors.initials: CW
authors.lastname: Freeman
authors.affiliation: University of Virginia, Charlottesville, USA.
authors.forename: Ray G
authors.initials: RG
authors.lastname: Norby
authors.affiliation: University of Virginia, Charlottesville, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carey
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis / Q000592:standards; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014680:Veins
chemical_list: D011188:Potassium