Abstract：
BACKGROUND: The incidence of cardiovascular complications may be higher in unilateral than in bilateral primary aldosteronism (PA). We compared non-invasive hemodynamics before and after targeted therapy of bilateral versus unilateral PA.
METHODS: Adrenal vein sampling was performed, and cardiovascular variables were recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n=114). In a subset of 40 patients (adrenalectomy n=20, spironolactone-based treatment n=20), hemodynamic recordings were again performed after 33 months of targeted PA treatment.
RESULTS: In initial cross-sectional analysis, 51 patients had bilateral and 63 had unilateral PA. The mean ages were 50.6 and 54.3 years (p=0.081), and body mass indexes were 30.3 and 30.6 kg/m2 (p=0.724), respectively. Aortic blood pressure and cardiac output did not significantly differ between the groups, but evaluated left cardiac work was ~10% higher in unilateral PA (p=0.022). In the followup study, initial and final blood pressure levels 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 in bilateral PA. After a median treatment time of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 liters in bilateral versus 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.
METHODS: Adrenal vein sampling was performed, and cardiovascular variables were recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n=114). In a subset of 40 patients (adrenalectomy n=20, spironolactone-based treatment n=20), hemodynamic recordings were again performed after 33 months of targeted PA treatment.
RESULTS: In initial cross-sectional analysis, 51 patients had bilateral and 63 had unilateral PA. The mean ages were 50.6 and 54.3 years (p=0.081), and body mass indexes were 30.3 and 30.6 kg/m2 (p=0.724), respectively. Aortic blood pressure and cardiac output did not significantly differ between the groups, but evaluated left cardiac work was ~10% higher in unilateral PA (p=0.022). In the followup study, initial and final blood pressure levels 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 in bilateral PA. After a median treatment time of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 liters in bilateral versus 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.
摘要：
背景：单侧心血管并发症的发生率可能高于双侧原发性醛固酮增多症（PA）。我们比较了双侧和单侧PA靶向治疗前后的非侵入性血流动力学。
方法：进行肾上腺静脉取样，使用桡动脉脉搏波分析和全身阻抗心动图记录心血管变量(n=114).在40例患者中（肾上腺切除术n=20，基于螺内酯的治疗n=20），在PA靶向治疗33个月后再次进行血流动力学记录.
结果：在初始横截面分析中，51例患者为双侧PA，63例患者为单侧PA。平均年龄分别为50.6和54.3岁（p=0.081），体重指数分别为30.3和30.6kg/m2（p=0.724），分别。两组之间的主动脉血压和心输出量没有显着差异，但单侧PA评估的左心功高出约10％（p=0.022）。在后续研究中,主动脉的初始和最终血压水平没有显着差异，而初始心输出量(+13%，p=0.015)和左心脏功(+17%，p=0.009）单侧PA高于双侧PA。中位治疗时间为33个月后，心脏负荷的差异被消除，和细胞外水容量减少了1.3和1.4升的双边与单边PA，分别（p=0.814）。
结论：这些结果表明，单侧PA比双侧PA对心脏的负担更大，为单侧疾病的心脏并发症发生率较高提供了可能的解释。用PA的靶向手术和药物治疗获得醛固酮诱导的体积过量的类似减少。
方法：进行肾上腺静脉取样，使用桡动脉脉搏波分析和全身阻抗心动图记录心血管变量(n=114).在40例患者中（肾上腺切除术n=20，基于螺内酯的治疗n=20），在PA靶向治疗33个月后再次进行血流动力学记录.
结果：在初始横截面分析中，51例患者为双侧PA，63例患者为单侧PA。平均年龄分别为50.6和54.3岁（p=0.081），体重指数分别为30.3和30.6kg/m2（p=0.724），分别。两组之间的主动脉血压和心输出量没有显着差异，但单侧PA评估的左心功高出约10％（p=0.022）。在后续研究中,主动脉的初始和最终血压水平没有显着差异，而初始心输出量(+13%，p=0.015)和左心脏功(+17%，p=0.009）单侧PA高于双侧PA。中位治疗时间为33个月后，心脏负荷的差异被消除，和细胞外水容量减少了1.3和1.4升的双边与单边PA，分别（p=0.814）。
结论：这些结果表明，单侧PA比双侧PA对心脏的负担更大，为单侧疾病的心脏并发症发生率较高提供了可能的解释。用PA的靶向手术和药物治疗获得醛固酮诱导的体积过量的类似减少。
