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Updated: Jun 21, 2025
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Targeted Treatment Reverses Increased Left Cardiac Work in Unilateral vs. Bilateral Primary Aldosteronism
Eeva Kokko1, Marianna Viukari2, Jenni K Koskela1,3
1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Insights
Unilateral primary aldosteronism (PA) places a greater cardiac workload than bilateral PA, potentially explaining higher complication rates. Both surgical and medical treatments effectively reduce aldosterone effects and volume overload.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Cardiovascular complications are potentially more frequent in unilateral primary aldosteronism (PA) compared to bilateral PA.
- This study investigates hemodynamic differences between unilateral and bilateral PA.
- Targeted therapy's impact on hemodynamics in unilateral versus bilateral PA is examined.
Purpose of the Study:
- To compare noninvasive hemodynamics in patients with unilateral versus bilateral primary aldosteronism (PA).
- To assess the effects of targeted PA treatment on cardiac workload and fluid balance.
- To explore the potential link between unilateral PA and increased cardiac burden.
Main Methods:
- Adrenal vein sampling was used to differentiate unilateral and bilateral PA.
- Hemodynamics were assessed using radial artery pulse wave analysis and whole-body impedance cardiography.
- 40 patients (20 adrenalectomy, 20 spironolactone treatment) underwent hemodynamic recordings at baseline and after 33 months of PA treatment.
Main Results:
- Initially, left cardiac work was approximately 10% higher in unilateral PA (P=0.022).
- After treatment, initial cardiac output (+13%, P=0.015) and left cardiac work (+17%, P=0.009) remained higher in unilateral PA.
- Treatment abolished differences in cardiac load, and extracellular water volume decreased similarly in both groups.
Conclusions:
- Unilateral PA imposes a greater cardiac burden than bilateral PA, possibly explaining higher cardiovascular complication rates.
- Targeted surgical or medical treatment of PA achieves similar reductions in aldosterone-induced volume excess.
- These findings highlight the distinct cardiac impact of unilateral PA and the efficacy of PA treatments.
Background:
The incidence of cardiovascular complications may be higher in unilateral than bilateral primary aldosteronism (PA). We compared noninvasive hemodynamics after targeted therapy of bilateral vs. unilateral PA.
Methods:
Adrenal vein sampling was performed, and hemodynamics recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n = 114). In 40 patients (adrenalectomy n = 20, spironolactone-based treatment n = 20), hemodynamic recordings were performed after 33 months of PA treatment.
Results:
In initial cross-sectional analysis, 51 patients had bilateral and 63 unilateral PA. The mean ages were 50.6 and 54.3 years (P = 0.081), and body mass indexes 30.3 and 30.6 kg/m2 (P = 0.724), respectively. Aortic blood pressure (BP) and cardiac output did not differ between the groups, but left cardiac work was ~10% higher in unilateral PA (P = 0.022). In the follow-up study, initial and final BPs in the aorta were not significantly different, while initial cardiac output (+13%, P = 0.015) and left cardiac work (+17%, P = 0.009) were higher in unilateral than bilateral PA. After median treatment of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 l in bilateral vs. unilateral PA, respectively (P = 0.814).
Conclusions:
These results suggest that unilateral PA burdens the heart more than bilateral PA, providing a possible explanation for the higher incidence of cardiac complications in unilateral disease. A similar reduction in aldosterone-induced volume excess was obtained with targeted surgical and medical treatment of PA.
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