We investigated the myocardial work derived from left ventricular pressure-strain loop in patients with primary aldosteronism or primary hypertension. We enrolled 50 patients with primary aldosteronism, 50 age- and sex-matched patients with primary hypertension, and 25 normotensive control subjects. We performed transthoracic echocardiography and speckle-tracking echocardiography-based left ventricular pressure-strain loop analysis to evaluate cardiac structure and function. Patients with primary aldosteronism and those with primary hypertension had similar clinic and ambulatory blood pressures, except that the former had a significantly (P = 0.03) higher nighttime systolic blood pressure. All subjects had normal left ventricular ejection fraction (66.4 ± 4.7%). Patients with primary aldosteronism had a greater left ventricular mass index than those with primary hypertension and the normal controls (111.0 ± 21.6 g/m² versus 95.7 ± 17.7 and 77.9 ± 13.5 g/m², respectively, P < 0.001). The global myocardial work index (GWI, 2336 ± 333, 2366 ± 288, and 2292 ± 249 mmHg%, respectively), and global constructive work (GCW, 2494 ± 325, 2524 ± 301, and 2391 ± 193 mmHg%, respectively), were comparable in the three groups (P ≥ 0.18). However, the global work efficiency (GWE) differed significantly (P < 0.001), being lowest in primary aldosteronism (91.1 ± 2.7%), intermediate in primary hypertension (93.5 ± 2.5%) and highest in controls (95.3 ± 1.5%). The opposite was true for the global wasted work (GWW) (205.6 ± 74.6, 142.0 ± 56.4 and 99.4 ± 33.7 mmHg%, respectively, P < 0.001). GWE was significantly correlated with the logarithmically transformed plasma concentration and the urinary excretion of aldosterone in patients with primary aldosteronism or primary hypertension (r = −0.43 for both, P < 0.001). The associations remained statistically significant (P ≤ 0.04) after further adjustment for several factors, including left ventricular mass index and clinic or nighttime blood pressure. In conclusion, GWE decreased and GWW increased in primary hypertension and further in primary aldosteronism, probably because of the adrenal aldosterone hypersecretion and the left ventricular mass index increase, while GWI and GCW were similar, indicating that similar and normalized total myocardial work might be a compensation in hypertension at the expense of work efficiency.

我们调查了原发性醛固酮增多症或原发性高血压患者左心室压力-应变环的心肌功。我们招募了 50 名原发性醛固酮增多症患者、50 名年龄和性别匹配的原发性高血压患者和 25 名血压正常对照受试者。我们进行了经胸超声心动图和基于斑点追踪超声心动图的左心室压力-应变环分析，以评估心脏结构和功能。原发性醛固酮增多症患者和原发性高血压患者的临床血压和动态血压相似，但前者有显着性差异（P = 0.03) 夜间收缩压升高。所有受试者的左心室射血分数均正常 (66.4 ± 4.7%)。原发性醛固酮增多症患者的左心室质量指数高于原发性高血压患者和正常对照组（分别为 111.0 ± 21.6 g/m ²对 95.7 ± 17.7 和 77.9 ± 13.5 g/m ²，P  < 0.001）。整体心肌做功指数（GWI，分别为 2336 ± 333、2366 ± 288 和 2292 ± 249 mmHg%）和整体建设性工作（GCW，分别为 2494 ± 325、2524 ± 301 和 2391 ± 193 mmHg%） , 三组具有可比性 ( P  ≥ 0.18)。然而，全球工作效率（GWE）差异显着（P < 0.001)，原发性醛固酮增多症最低 (91.1 ± 2.7%)，原发性高血压居中 (93.5 ± 2.5%)，对照组最高 (95.3 ± 1.5%)。全球浪费工作 (GWW) 则相反（分别为 205.6 ± 74.6、142.0 ± 56.4 和 99.4 ± 33.7 mmHg%，P  < 0.001）。GWE与原发性醛固酮增多症或原发性高血压患者的对数转换血浆浓度和醛固酮尿排泄显着相关（两者的r  = -0.43，P  <0.001）。这些关联仍然具有统计学意义（P ≤ 0.04）在对几个因素进行进一步调整后，包括左心室质量指数和临床或夜间血压。总之，原发性高血压和原发性醛固酮增多症的 GWE 下降和 GWW 增加，可能是由于肾上腺醛固酮分泌过多和左心室质量指数增加，而 GWI 和 GCW 相似，表明相似和标准化的总心肌做功可能是以牺牲工作效率为代价补偿高血压。