Application Of Contralateral Suppression Index In The Classification Of Primary Aldosteronism By Adrenal Venous Sampling

Objective : To explore the application of Contralateral suppression Index(CSI)in the classification of adrenal venous sampling(AVS)in patients with primary aldosteronism(PA)hypertension.Methods : A total of 66 patients with PA,using AVS diagnosed after aldosterone/renin ratio(ARR)screening and diagnosis/exclusion test(captopril or saline stress test)were collected from January 2019 to December 2022 in The First People?s Hospital of Yinchuan.Among 66 cases,57 cases were successful in double intubation,7 cases were successful in single intubation,and 2 cases were failed in double intubation.The success rate of AVS was counted;64 cases of double/single intubation were divided into two group based on CSI,CSI<1 was the dominant secretion group,41 cases in total,CSI ≥ 1 was the non-dominant secretion group,23 cases in total,and the differences of general and biochemical data between the two groups were compared;Compare the consistency rate of traditional adrenal CT and AVS classification;Kappa consistency test was used to determine the consistency between CSI and the commonly used Lateralization Index(LI)in the AVS results judgment;According to the subject working curve(ROC),the best diagnostic cut-off point of CSI was obtained.Results : 1.66 patients with PA were 48.5 ± 11.1 years old,including 36 males and 30 females.AVS intubation was successful bilaterally in 57 cases(86.36%),unilateral in 7 cases(10.61%),and unsuccessful bilateral in 2 cases(3.03%).Among 66 cases,30 cases(45.45%)were complicated with hypokalemia;48 cases(72.7%)of adrenal CT showed nodules/hyperplasia.2.64 cases of successful double/single intubation were divided into two groups based on CSI.CSI<1 was the dominant secretion group,41 cases in total,and CSI ≥ 1 was the non-dominant secretion group,23 cases in total.The duration of disease in the dominant secretory group was longer than that in the non-dominant secretory group [3.0(2.0,12.5)years compared with 2.0(0.3,4.0)years,P=0.017],urinary potassium was higher [(53.69 ± 20.29)(mmol/24h)than(43.41±12.74)(mmol/24h),P=0.032],recumbent-aldosterone[214.00(145.66,378.04)(pg/m L)compared with 141.00(56.70,214.00)(pg/m L),P=0.002],and the level of recumbent-ARR [114.84(62.01,307.87)compared with44.81(13.85,138.60),P=0.008] higher.There was no statistical difference between systolic blood pressure [(150 ± 21)mm Hg vs(146 ± 21)mm Hg,P=0.453]and diastolic blood pressure [(92 ± 13)mm Hg vs(90 ± 16)mm Hg,P=0.561]between the two groups.3.The total consistent rate of AVS and adrenal CT in the diagnosis of the dominant side was 53.13%(34/64).Among the patients identified as the dominant secretion and non-dominant secretion by AVS,the consistent rate of diagnosis of both was 51.22%(21/41)and 56.52%(13/23).4.CSI and LI have medium consistency,Kappa value 0.711,P<0.001.The area under the ROC of CSI is 0.918,and the 95% confidence interval(CI)is(0.828-1.000,P<0.001).When the best diagnostic cut-off point is 1.010,the highest Jordan index is 0.807.Conclusion :1.Only part of the PA patients are complicated with hypokalemia and adrenal CT changes.2.Among the patients with PA,the patients with dominant secretion have longer course of disease,and higher urinary potassium,recumbent-aldosterone and recumbent-ARR.3.The diagnostic consistency of adrenal CT and AVS for classification is not high,and AVS should be performed for PA to be operated.4.CSI is moderately consistent with LI,which can be used as an effective supplementary indicator of AVS unilateral intubation failure.