[Characteristics of left ventricular structure and function and their influencing factors in elderly individuals with...

Objective: To examine the differences in left heart structure and function between elderly patients with primary aldosteronism (PA) and those with primary hypertension (EH), and identify factors influencing left heart structure and function in elderly PA patients. Methods: A total of 264 elderly PA patients and 266 EH patients diagnosed at Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to July 2023 were retrospectively included. Propensity score matching (PSM) was performed at a 1: 1 ratio based on age, gender ratio, and blood pressure. The clinical indicators and cardiac differences were compared between the two groups. Multiple linear regression model was utilized to pinpoint risk factors associated with alterations in cardiac structure and function. Results: Each group included 147 patients. PA group had 61 males and 86 females, and aged [M (Q₁, Q₃)] 66 (63, 69) years; EH group had 63 males and 84 females, and aged 67 (63, 70) years. Patients with PA exhibit increased left ventricular mass index (LVMI), left atrial diameter (LAD), and interventricular septum thickness (IVST) (all P<0.05). There were no statistically significant differences in the left ventricular ejection fraction (LVEF) and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e') between the two groups (both P>0.05). Multiple linear regression analysis revealed that plasma aldosterone concentration (β=0.162, 95%CI: 0.138 to 0.186, P=0.030), systolic blood pressure (β=0.163, 95%CI: 0.053 to 0.273, P=0.026), and plasma renin concentration (β=0.243, 95%CI: 0.039 to 0.447, P=0.002) were linked to LVMI; body mass index (β=0.260, 95%CI: 0.125 to 0.395, P=0.001), systolic blood pressure (β=0.207, 95%CI: 0.187 to 0.227, P=0.004), plasma renin concentration (β=0.155, 95%CI: 0.090 to 0.220, P=0.031), and age (β=0.212, 95%CI: 0.130 to 0.294, P=0.003) were associated with LAD; and body mass index (β=0.165, 95%CI: 0.122 to 0.208, P=0.010), HDL cholesterol (β=-0.192, 95%CI:-0.294 to -0.090, P=0.004), and plasma aldosterone concentration (β=0.151, 95%CI: 0.149 to 0.153, P=0.016) were related to IVST in PA group patients. Patients with aldosterone adenoma had a higher left ventricular mass index than those with adrenal hyperplasia [94 (81, 103) g/m² vs 81 (70, 98) g/m², P=0.039]. Conclusions: Elderly PA patients exhibit greater left ventricular hypertrophy and left atrial enlargement than age, gender, and blood pressure-matched elderly EH patients, though both groups show similar left ventricular function. In elderly PA patients, aldosterone and renin levels are significantly linked to changes in left ventricular structure. Patients with aldosterone adenoma exhibit more severe left heart hypertrophy than patients with adrenal hyperplasia.