Context

Primary aldosteronism (PA) causes left ventricular hypertrophy (LVH) via hemodynamic factors and directly by aldosterone effects. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy (ADX) has been reported to improve LVH. However, the cardiovascular benefit could depend on plasma renin concentration (PRC) in patients on MRA.

Patients and objective

We analyzed data from 184 patients from the Munich center of the German Conn’s Registry, who underwent echocardiography at the time of diagnosis and 1 year after treatment. To assess the effect of PRC on cardiac recovery, we stratified patients on MRA according to suppression (n = 46) or non-suppression of PRC (n = 59) at follow-up and compared them to PA patients after ADX (n = 79).

Results

At baseline, patients treated by ADX or MRA had comparable left ventricular mass index (LVMI, 61.7 vs 58.9 g/m^2.7, P = 0.591). Likewise, patients on MRA had similar LVMI at baseline, when stratified into treatment groups with suppressed and unsuppressed PRC during follow-up (60.0 vs 58.1 g/m^2.7, P = 0.576). In all three groups, we observed a significant reduction in LVMI following treatment (P < 0.001). However, patients with suppressed PRC had no decrease in pro-BNP levels, and the reduction of LVMI was less intense than in patients with unsuppressed PRC (4.1 vs 8.2 g/m^2.7, P = 0.033) or after ADX (9.3 g/m^2.7, P = 0.019). Similarly, in multivariate analysis, higher PRC was correlated with the regression of LVH.

Conclusion

PA patients with suppressed PRC on MRA show impaired regression of LVH. Therefore, dosing of MRA according to PRC could improve their cardiovascular benefit.

中文翻译：

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肾素是原发性醛固酮增多症左心室肥大的标志物：一项队列研究

语境

原发性醛固酮增多症 (PA) 通过血流动力学因素和醛固酮效应直接导致左心室肥厚 (LVH)。据报道，盐皮质激素受体拮抗剂 (MRA) 或肾上腺切除术 (ADX) 的特定治疗可改善 LVH。然而，心血管获益可能取决于 MRA 患者的血浆肾素浓度 (PRC)。

患者和目标

我们分析了来自德国康恩登记处慕尼黑中心的 184 名患者的数据，这些患者在诊断时和治疗后 1 年接受了超声心动图检查。为了评估PRC对心脏恢复的影响，我们在随访时根据PRC抑制（ n =  46）或PRC不抑制（n =  59）对MRA患者进行分层，并将其与ADX后的PA患者（ n =  79 ）进行比较）。

结果

在基线时，接受 ADX 或 MRA 治疗的患者的左心室质量指数相当（LVMI，61.7 vs 58.9 g/m ^2.7，P = 0.591）。同样，MRA 患者在基线时具有相似的 LVMI，当在随访期间分层为具有抑制和未抑制 PRC 的治疗组时（60.0 vs 58.1 g/m ^2.7，P =  0.576）。在所有三组中，我们观察到治疗后 LVMI 显着降低（P < 0.001）。然而，PRC 被抑制的患者 pro-BNP 水平没有下降，LVMI 的降低不如 PRC 未抑制的患者（4.1 vs 8.2 g/m ^2.7，P =  0.033）或 ADX 后（9.3 g/m ^2.7 , P = 0.019)。同样，在多变量分析中，较高的 PRC 与 LVH 的回归相关。

结论

在 MRA 上具有抑制 PRC 的 PA 患者显示 LVH 的退化受损。因此，根据PRC的MRA剂量可以提高他们的心血管益处。