Multimodality Imaging in Aldosterone-Induced Cardiomyopathy: Early Detection and Prognostic Implications

Area of Science:

• Cardiology
• Endocrinology
• Medical Imaging

Background:

• Primary aldosteronism (PA) is the leading cause of secondary hypertension.
• Aldosterone excess independently drives adverse cardiac remodeling, including fibrosis and hypertrophy.
• This leads to a distinct, often underdiagnosed, cardiomyopathy.

Purpose of the Study:

• To review the pathophysiology of aldosterone-induced cardiac remodeling.
• To assess the role of multimodality cardiac imaging in PA.
• To evaluate treatment effects and identify research gaps.

Main Methods:

• Narrative review of current literature.
• Focus on echocardiography and cardiac magnetic resonance (CMR) techniques (T1 mapping, LGE).
• Analysis of pathophysiological mechanisms and imaging biomarkers.

Main Results:

• Aldosterone excess causes myocardial fibrosis, hypertrophy, and diastolic dysfunction.
• Echocardiography and CMR enable non-invasive assessment of cardiac changes.
• Gaps exist in understanding subclinical changes, long-term prognosis, and treatment impacts.

Conclusions:

• Multimodality imaging is crucial for assessing PA-related cardiac damage.
• Standardized criteria and further research on prognostic biomarkers and treatment effects are needed.
• Personalized care and improved outcomes in PA patients require integrated imaging strategies.