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Speckle Tracking Echocardiographic Layer-specific Strain Analysis on Subclinical Left Ventricular Dysfunction in Patients with Primary Aldosteronism.
American Journal of Hypertension 2018 November 22
Background: Primary aldosteronism (PA) may cause myocardial injury. We investigated myocardial dysfunction using speckle tracking echocardiographic (STE) layer-specific strain in patients with PA.
Methods: Our study included 62 patients with PA (33 aldosterone-producing adenoma [APA] and 29 idiopathic hyperaldosteronism [IHA]) and 30 patients with primary hypertension. STE was acquired using the GE Vivid E9 equipment. The longitudinal (LS) and circumferential (CS) layer-specific strains of the endocardium, mid-myocardium and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid and CSepi) were obtained using the EchoPAC BT13 workstation.
Results: Patients with APA, compared to those with primary hypertension and IHA had a significantly (P<0.001) lower serum potassium concentration and plasma renin activity, and higher 24-h urinary aldosterone, plasma aldosterone concentration and aldosterone-to-renin ratio. Left ventricular ejection fraction was normal in all patients (58% to 60%). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all three groups (P<0.01). However, LSendo and CSendo were lowest in APA (-20.2±2.3% and -33.3±3.2%), intermediate in IHA (-22.1±1.9% and -35.7±2.8%) and highest in primary hypertension (-24.1±2.1% and -38.9±3.1%, P<0.001). Similar trends were observed for LSmid, LSepi, CSmid and CSepi, but statistical significance was only reached for the comparison between APA and primary hypertension (P<0.001), but not others (P>0.05). Layer-specific strain was significantly corelated with plasma aldosterone concentration for all echocardiographic parameters (r-0.69 to -0.53, P<0.001) in all three groups.
Conclusions: Patients with PA, especially APA, had impaired regional systolic function with myocardial deformation changes at similar levels of blood pressure, probably because of elevated plasma aldosterone concentration.
Methods: Our study included 62 patients with PA (33 aldosterone-producing adenoma [APA] and 29 idiopathic hyperaldosteronism [IHA]) and 30 patients with primary hypertension. STE was acquired using the GE Vivid E9 equipment. The longitudinal (LS) and circumferential (CS) layer-specific strains of the endocardium, mid-myocardium and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid and CSepi) were obtained using the EchoPAC BT13 workstation.
Results: Patients with APA, compared to those with primary hypertension and IHA had a significantly (P<0.001) lower serum potassium concentration and plasma renin activity, and higher 24-h urinary aldosterone, plasma aldosterone concentration and aldosterone-to-renin ratio. Left ventricular ejection fraction was normal in all patients (58% to 60%). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all three groups (P<0.01). However, LSendo and CSendo were lowest in APA (-20.2±2.3% and -33.3±3.2%), intermediate in IHA (-22.1±1.9% and -35.7±2.8%) and highest in primary hypertension (-24.1±2.1% and -38.9±3.1%, P<0.001). Similar trends were observed for LSmid, LSepi, CSmid and CSepi, but statistical significance was only reached for the comparison between APA and primary hypertension (P<0.001), but not others (P>0.05). Layer-specific strain was significantly corelated with plasma aldosterone concentration for all echocardiographic parameters (r-0.69 to -0.53, P<0.001) in all three groups.
Conclusions: Patients with PA, especially APA, had impaired regional systolic function with myocardial deformation changes at similar levels of blood pressure, probably because of elevated plasma aldosterone concentration.
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