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Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism

BACKGROUND: Primary aldosteronism can cause cardiac dysfunction, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement. A few studies have compared the cardioprotective effects between surgery and medication for primary aldosteronism, although mo...

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Autores principales: Ueda, Tomomi, Tsurutani, Yuya, Osada, Jun, Inoue, Kosuke, Hoshino, Yoshitomo, Ono, Masato, Nakai, Kazuki, Saito, Jun, Yumoto, Kazuhiko, Nishikawa, Tetsuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9333367/
https://www.ncbi.nlm.nih.gov/pubmed/35766291
http://dx.doi.org/10.1161/JAHA.121.023813
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author Ueda, Tomomi
Tsurutani, Yuya
Osada, Jun
Inoue, Kosuke
Hoshino, Yoshitomo
Ono, Masato
Nakai, Kazuki
Saito, Jun
Yumoto, Kazuhiko
Nishikawa, Tetsuo
author_facet Ueda, Tomomi
Tsurutani, Yuya
Osada, Jun
Inoue, Kosuke
Hoshino, Yoshitomo
Ono, Masato
Nakai, Kazuki
Saito, Jun
Yumoto, Kazuhiko
Nishikawa, Tetsuo
author_sort Ueda, Tomomi
collection PubMed
description BACKGROUND: Primary aldosteronism can cause cardiac dysfunction, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement. A few studies have compared the cardioprotective effects between surgery and medication for primary aldosteronism, although most have not adjusted for baseline disease status. In this study, we investigated the difference in cardiovascular outcomes between surgery and medication treatment for primary aldosteronism after adjusting for baseline clinical characteristics, including aldosterone level and pretreatment echocardiographic information. METHODS AND RESULTS: We retrospectively analyzed 220 patients diagnosed with primary aldosteronism who underwent adrenalectomy (n=144) or medication treatment (n=76) between 2009 and 2019. Echocardiographic changes were evaluated pretreatment and 1 year posttreatment. The surgery group had lower potassium, lower plasma renin activity, and higher plasma aldosterone concentration than the medication group, indicating a severe primary aldosteronism phenotype in the former. The decrease in left ventricular mass index after treatment was significantly greater in the surgery group than in the medication group (P=0.047). However, this relationship was not noted after multivariable regression analysis (standard β=−0.08, P=0.17). Additionally, decreased parameter values related to left ventricular diastolic dysfunction and left atrial enlargement were not different between the groups. Pretreatment echocardiographic values were most associated with changes in all echocardiographic parameters. The findings were consistent in the propensity score‐matched analysis. CONCLUSIONS: This study's findings suggest that there is no difference in cardioprotective efficacy between surgical and medication treatment under similar disease severity; however, it should be considered that several study participants with severe hyperaldosteronism were managed surgically.
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spelling pubmed-93333672022-07-30 Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism Ueda, Tomomi Tsurutani, Yuya Osada, Jun Inoue, Kosuke Hoshino, Yoshitomo Ono, Masato Nakai, Kazuki Saito, Jun Yumoto, Kazuhiko Nishikawa, Tetsuo J Am Heart Assoc Original Research BACKGROUND: Primary aldosteronism can cause cardiac dysfunction, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement. A few studies have compared the cardioprotective effects between surgery and medication for primary aldosteronism, although most have not adjusted for baseline disease status. In this study, we investigated the difference in cardiovascular outcomes between surgery and medication treatment for primary aldosteronism after adjusting for baseline clinical characteristics, including aldosterone level and pretreatment echocardiographic information. METHODS AND RESULTS: We retrospectively analyzed 220 patients diagnosed with primary aldosteronism who underwent adrenalectomy (n=144) or medication treatment (n=76) between 2009 and 2019. Echocardiographic changes were evaluated pretreatment and 1 year posttreatment. The surgery group had lower potassium, lower plasma renin activity, and higher plasma aldosterone concentration than the medication group, indicating a severe primary aldosteronism phenotype in the former. The decrease in left ventricular mass index after treatment was significantly greater in the surgery group than in the medication group (P=0.047). However, this relationship was not noted after multivariable regression analysis (standard β=−0.08, P=0.17). Additionally, decreased parameter values related to left ventricular diastolic dysfunction and left atrial enlargement were not different between the groups. Pretreatment echocardiographic values were most associated with changes in all echocardiographic parameters. The findings were consistent in the propensity score‐matched analysis. CONCLUSIONS: This study's findings suggest that there is no difference in cardioprotective efficacy between surgical and medication treatment under similar disease severity; however, it should be considered that several study participants with severe hyperaldosteronism were managed surgically. John Wiley and Sons Inc. 2022-06-29 /pmc/articles/PMC9333367/ /pubmed/35766291 http://dx.doi.org/10.1161/JAHA.121.023813 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Ueda, Tomomi
Tsurutani, Yuya
Osada, Jun
Inoue, Kosuke
Hoshino, Yoshitomo
Ono, Masato
Nakai, Kazuki
Saito, Jun
Yumoto, Kazuhiko
Nishikawa, Tetsuo
Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism
title Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism
title_full Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism
title_fullStr Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism
title_full_unstemmed Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism
title_short Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism
title_sort comparison of echocardiographic changes between surgery and medication treatment in patients with primary aldosteronism
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9333367/
https://www.ncbi.nlm.nih.gov/pubmed/35766291
http://dx.doi.org/10.1161/JAHA.121.023813
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