Aldosterone induces left ventricular subclinical systolic dysfunction: a strain imaging study.

Area of Science:

• Cardiology
• Endocrinology
• Hypertension Research

Background:

• Primary aldosteronism is linked to increased left ventricular (LV) hypertrophy and diastolic dysfunction compared to essential hypertension.
• Subclinical systolic function impairments, undetectable by standard endocardial measurements, can be identified using speckle-tracking echocardiography.
• Aldosterone's specific impact on subclinical systolic dysfunction requires further investigation.

Purpose of the Study:

• To investigate subclinical impairments in left ventricular systolic function induced by aldosterone.
• To compare myocardial strain parameters between patients with primary aldosteronism and essential hypertension.

Main Methods:

• Prospective enrollment of patients diagnosed with primary aldosteronism and essential hypertension.
• Analysis of clinical, biochemical, and echocardiographic data, including global longitudinal strain (GLS).

Main Results:

• Patients with primary aldosteronism exhibited significantly lower serum potassium, lower plasma renin activity, and higher aldosterone-to-renin ratio (ARR) and 24-h urinary aldosterone levels.
• Primary aldosteronism group showed increased ventricular wall thickness and LV mass index.
• A significant reduction in GLS was observed in primary aldosteronism patients compared to essential hypertension patients (-17.84 ± 2.36 vs. -20.13 ± 2.32, P < 0.001).
• GLS correlated with serum potassium, LV mass index, plasma renin activity, ARR, and 24-h urinary aldosterone levels.
• Multivariate analysis identified ARR and 24-h urinary aldosterone as independent factors associated with GLS.

Conclusions:

• Patients with primary aldosteronism demonstrate a lower magnitude of global longitudinal strain (GLS) compared to those with essential hypertension.
• These findings suggest that aldosterone directly induces a subclinical decline in left ventricular systolic function.