Impact Of Left Ventricular Geometry On Hypertension Outcome Of Adrenalectomy In Primary Aldosteronism Patients

Objective Left ventricular remodeling can be clinically defined as changes in the size, shape and function of the heart after cardiac injury. Adverse loading conditions and cardiac injury lead to remodeling of the heart into different patterns of left ventricular(LV) geometry. Data on predictors of cardiovascular lesion after adrenalectomy in primary aldosteronism(PA) are limited. Echocardiography was routinely utilized to visualize the morphological consequences of cardiac remodeling on left ventricular geometry. Thus, in our cohort, LV geometry was chosen as the impact factor of hypertension outcome of adrenalectomy in PA patients.Methods 125 patients with PA who underwent unilateral adrenalectomy between 2008 and 2014 were reviewed retrospectively. Patients were distributed into two groups according to whether blood pressure(BP) was normal without antihypertensive medications 1 year postoperatively. Clinical and biochemical data were evaluated at baseline and at 1 year follow-up. These groups were compared using the Student's test, chi-square test or Wilcoxon rank sum test as appropriate. A P value of less than 0.05 was judged statistically significant. Binary logistic regression model was carried out on variables demonstrating statistical significance in the univariate modeling. All Statistical analyses were carried out using SPSS 17.0.Results At 1 year, blood pressure had normalized in 68% of the patients without antihypertensive medications. Binary logistic regression analysis revealed that duration of hypertension ?6 years(OR(95%CI) = 5.68(1.94–16.59), P = 0.002), preoperative antihypertensive ? 2(OR(95% CI) = 3.41(1.28–9.11), P = 0.014) and absent of LVH(OR(95% CI) = 3.41(1.34–8.63), P = 0.010) were remained significantly associated with cure during follow-up times. In both unadjusted and adjusted models, CR, EH and CH were statistically significantly associated with hypertension outcome of post-adrenalectomy. The correlation revealed a stepwise increase among the 4 LV geometric patterns when NG was used as a reference.Conclusion Left ventricular geometry is closely associated with hypertension outcome of patients with PA who underwent adrenalectomy. Improvements in left ventricular geometry, including both CR and LVH, may be associated with overall benefits on prognosis of hypertension outcome after adrenalectomy in PA patients. More studies are needed to determine strategies to reduce abnormal left ventricular geometry.These important findings emphasize the importance of early diagnosis and intervention of primary aldosteronism.