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Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria
BACKGROUND: Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown. OBJECTIVE: To compare anatomical and functional remodeling of left ventricle...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9969461/ https://www.ncbi.nlm.nih.gov/pubmed/36860935 http://dx.doi.org/10.1177/20406223221143253 |
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author | Kao, Ting-Wei Wu, Xue-Ming Liao, Che-Wei Tsai, Cheng-Hsuan Chen, Zheng-Wei Chang, Yi-Yao Lee, Bo-Ching Chiu, Yu-Wei Lai, Tai-Shuan Wu, Vin-Cent Lin, Yen-Hung Hung, Chi-Sheng |
author_facet | Kao, Ting-Wei Wu, Xue-Ming Liao, Che-Wei Tsai, Cheng-Hsuan Chen, Zheng-Wei Chang, Yi-Yao Lee, Bo-Ching Chiu, Yu-Wei Lai, Tai-Shuan Wu, Vin-Cent Lin, Yen-Hung Hung, Chi-Sheng |
author_sort | Kao, Ting-Wei |
collection | PubMed |
description | BACKGROUND: Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown. OBJECTIVE: To compare anatomical and functional remodeling of left ventricle (LV) in PA patients with or without albuminuria. DESIGN: Prospective cohort study. METHODS: The cohort was separated into two arms according to the presence or absence of albuminuria (>30 mg/g of morning spot urine). Propensity score matching with age, sex, systolic blood pressure, and diabetes mellitus was performed. Multivariate analysis was conducted with adjustments for age, sex, body mass index, systolic blood pressure, duration of hypertension, smoking, diabetes mellitus, number of antihypertensive agents, and aldosterone level. A local-linear model with bandwidth of 2.07 was used to study correlations. RESULTS: A total of 519 individuals with PA were enrolled in the study, of whom 152 had albuminuria. After matching, the albuminuria group had a higher creatinine level, at baseline. With regard to LV remodeling, albuminuria was independently associated with a significantly higher interventricular septum (1.22 > 1.17 cm, p = 0.030), LV posterior wall thickness (1.16 > 1.10 cm, p = 0.011), LV mass index (125 > 116 g/m(2), p = 0.023), and medial E/e′ ratio (13.61 > 12.30, p = 0.032), and a lower medial early diastolic peak velocity (5.70 < 6.36 cm/s, p = 0.016). Multivariate analysis further revealed that albuminuria was an independent risk factor for elevated LV mass index (p < 0.001) and medial E/e′ ratio (p = 0.010). Non-parametric kernel regression also demonstrated that the level of albuminuria was positively correlated with LV mass index. The remodeling of LV mass and diastolic function under the presence of albuminuria distinctly improved after PA treatment. CONCLUSION: The presence of concomitant albuminuria in patients with PA was associated with pronounced LV hypertrophy and compromised LV diastolic function. These alterations were reversible after treatment for PA. PLAIN LANGUAGE SUMMARY: Cardiac Impact of Primary Aldosteronism and Albuminuria Primary aldosteronism and albuminuria has been, respectively, demonstrated to bring about left ventricular remodeling, but the aggregative effect was unknown. We constructed a prospective single-center cohort study in Taiwan. We proposed the presence of concomitant albuminuria was associated with left ventricular hypertrophy and compromised diastolic function. Intriguingly, management of primary aldosteronism was able to restore these alterations. Our study delineated the cardiorenal crosstalk in the setting of secondary hypertension and the role of albuminuria for left ventricular remodeling. Future interrogations toward the underlying pathophysiology as well as therapeutics will facilitate the improvement of holistic care for such population. |
format | Online Article Text |
id | pubmed-9969461 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-99694612023-02-28 Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria Kao, Ting-Wei Wu, Xue-Ming Liao, Che-Wei Tsai, Cheng-Hsuan Chen, Zheng-Wei Chang, Yi-Yao Lee, Bo-Ching Chiu, Yu-Wei Lai, Tai-Shuan Wu, Vin-Cent Lin, Yen-Hung Hung, Chi-Sheng Ther Adv Chronic Dis Original Research BACKGROUND: Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown. OBJECTIVE: To compare anatomical and functional remodeling of left ventricle (LV) in PA patients with or without albuminuria. DESIGN: Prospective cohort study. METHODS: The cohort was separated into two arms according to the presence or absence of albuminuria (>30 mg/g of morning spot urine). Propensity score matching with age, sex, systolic blood pressure, and diabetes mellitus was performed. Multivariate analysis was conducted with adjustments for age, sex, body mass index, systolic blood pressure, duration of hypertension, smoking, diabetes mellitus, number of antihypertensive agents, and aldosterone level. A local-linear model with bandwidth of 2.07 was used to study correlations. RESULTS: A total of 519 individuals with PA were enrolled in the study, of whom 152 had albuminuria. After matching, the albuminuria group had a higher creatinine level, at baseline. With regard to LV remodeling, albuminuria was independently associated with a significantly higher interventricular septum (1.22 > 1.17 cm, p = 0.030), LV posterior wall thickness (1.16 > 1.10 cm, p = 0.011), LV mass index (125 > 116 g/m(2), p = 0.023), and medial E/e′ ratio (13.61 > 12.30, p = 0.032), and a lower medial early diastolic peak velocity (5.70 < 6.36 cm/s, p = 0.016). Multivariate analysis further revealed that albuminuria was an independent risk factor for elevated LV mass index (p < 0.001) and medial E/e′ ratio (p = 0.010). Non-parametric kernel regression also demonstrated that the level of albuminuria was positively correlated with LV mass index. The remodeling of LV mass and diastolic function under the presence of albuminuria distinctly improved after PA treatment. CONCLUSION: The presence of concomitant albuminuria in patients with PA was associated with pronounced LV hypertrophy and compromised LV diastolic function. These alterations were reversible after treatment for PA. PLAIN LANGUAGE SUMMARY: Cardiac Impact of Primary Aldosteronism and Albuminuria Primary aldosteronism and albuminuria has been, respectively, demonstrated to bring about left ventricular remodeling, but the aggregative effect was unknown. We constructed a prospective single-center cohort study in Taiwan. We proposed the presence of concomitant albuminuria was associated with left ventricular hypertrophy and compromised diastolic function. Intriguingly, management of primary aldosteronism was able to restore these alterations. Our study delineated the cardiorenal crosstalk in the setting of secondary hypertension and the role of albuminuria for left ventricular remodeling. Future interrogations toward the underlying pathophysiology as well as therapeutics will facilitate the improvement of holistic care for such population. SAGE Publications 2023-01-18 /pmc/articles/PMC9969461/ /pubmed/36860935 http://dx.doi.org/10.1177/20406223221143253 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Kao, Ting-Wei Wu, Xue-Ming Liao, Che-Wei Tsai, Cheng-Hsuan Chen, Zheng-Wei Chang, Yi-Yao Lee, Bo-Ching Chiu, Yu-Wei Lai, Tai-Shuan Wu, Vin-Cent Lin, Yen-Hung Hung, Chi-Sheng Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
title | Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
title_full | Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
title_fullStr | Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
title_full_unstemmed | Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
title_short | Anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
title_sort | anatomical and functional remodeling of left ventricle in patients with primary aldosteronism and concomitant albuminuria |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9969461/ https://www.ncbi.nlm.nih.gov/pubmed/36860935 http://dx.doi.org/10.1177/20406223221143253 |
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