Abstract 2516: Primary Aldosteronism And Inappropriateness Of Left Ventricular Mass
Background: The calculation of values of left ventricular mass (LVM) exceeding individual needs to compensate haemodynamic load (inappropriate LVM) can identify patients with high CV risk (de Simone J. Hypertens 2001, Muiesan Hypertens 2007). However, a substantial percentage of LVM variance remains unexplained, even when the influence of cardiac workload, of the body size and gender are taken into account. It is possibile that other factors, non hemodynamic (genetic) or neurohumoral (renin-angiotensin-aldosterone system) may explain the individual LVM.
Aim of this study to evaluate the prevalence of inappropriate LVM (iLVM) in patients with primary aldosteronism (PA).
Methods 94 PA (51 with adrenal hyperplasia and 43 with adrenal adenoma), (age 49 ± 11 years, 41 F) and in 94 essential hypertensives (EHT) matched for age and sex, underwent echocardiography. The appropriateness of LVM to cardiac workload was calculated by the ratio of observed LVM to the value predicted for an individual gender, height, and stroke work at rest, from a reference population (de Simone et al, 1998). All subjects underwent laboratory examinations, including PRA and plasma aldosterone, and clinic and 24 hours blood pressure measurement.
Results No significant differences were observed for clinic and 24 hours BP, clinic and 24 hours heart rate, glucose and lipids between PA and EHT. The prevalence of traditionally defined LV hypertrophy (LVMI ≥ 47 g/m2.7in F and 50g/m2.7 in M) was greater in PA patients than in EHT (48 vs 19 % chi2 = 0.02). In patients without LVH, the prevalence of iLVM (> 128% of predicted) was also greater in patients with PA than in EHT controls, (14 % vs 2.5 %, chi2 p = 0.012). Among PA those with iLVM had a higher BMI, increased uric acid, lower midwall fractional shortening, and prolonged isovolumic relaxation time (p < 0.05 at least). In all patients a small, albeit statistically significant, correlation was observed between the Aldosterone/PRA levels and the ratio of observed/predicted LVM (r = 0.18, p < 0.02).
Conclusions: In patients with PA the prevalence of iLVM is increased, even in the absence of traditionally defined LVH. The increase in aldosterone levels could contribute to the increase of LV mass exceeding the amount needed to compensate hemodynamic load.