Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary
Tomomi Ueda1,2, Yuya Tsurutani1, Jun Osada2
1Endocrinology and Diabetes Center Yokohama Rosai Hospital Yokohama Japan.
Insights
Surgery and medication offer similar heart protection for primary aldosteronism when disease severity is comparable. Baseline patient characteristics significantly influence echocardiographic outcomes post-treatment.
Area of Science:
- Cardiology
- Endocrinology
- Medical Research
Background:
- Primary aldosteronism (PA) is linked to cardiac dysfunction, including left ventricular hypertrophy and diastolic dysfunction.
- Limited research compares surgical versus medication treatment for PA's cardioprotective effects, often without adjusting for baseline disease severity.
Purpose of the Study:
- To investigate cardiovascular outcome differences between surgery and medication for PA.
- To adjust for baseline clinical factors, including aldosterone levels and echocardiographic data, for a more accurate comparison.
Main Methods:
- Retrospective analysis of 220 PA patients (adrenalectomy n=144, medication n=76) from 2009-2019.
- Echocardiographic evaluation pre- and 1-year post-treatment.
- Multivariable regression and propensity score-matched analyses were employed.
Main Results:
- The surgery group exhibited a more severe PA phenotype at baseline.
- While the surgery group showed a greater initial decrease in left ventricular mass index, this was not significant after multivariable adjustment.
- No significant differences in improvements for diastolic dysfunction or left atrial enlargement were observed between groups.
Conclusions:
- Surgical and medication treatments for primary aldosteronism demonstrate comparable cardioprotective efficacy when baseline disease severity is similar.
- Pre-treatment echocardiographic parameters are strong predictors of post-treatment changes.
- The study acknowledges a potential bias due to surgical management of more severe PA cases.
Abstract:
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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