The differentiation between primary aldosteronism and essential hypertension in left ventricular remodeling before and after treatment: a follow-up study with quantitative stress cardiac magnetic resonance imaging.

BACKGROUND

Primary aldosteronism (PA) is associated with adverse cardiovascular outcomes. Elevated aldosterone levels in PA contribute to cardiac remodeling. This study aimed to apply cardiac magnetic resonance imaging (MRI) to longitudinally compare cardiac remodeling changes before and after targeted therapy between patients with PA and those with essential hypertension (EH) and to identify independent clinical predictors of left ventricular remodeling.

METHODS

We studied 75 consecutive patients with PA and 75 with EH. Patients with PA were treated with surgery, while patients with EH received pharmacotherapy. Clinical characteristics and MRI findings were collected at baseline and 6 months after treatment. Generalized estimating equations were applied to compare the changes in MRI variables. The relationship between the left ventricular remodeling parameters and physiological variables was analyzed via linear regression.

RESULTS

Median left ventricular mass {PA: 97 [interquartile range (IQR), 85-109] g; EH: 87 (IQR, 76-102) g; P=0.015} and mass index [PA: 54.40 (IQR, 47.22-65.22) g/m2; EH: 50.54 (IQR, 41.95-61.83) g/m2; P=0.009] were higher in the patients with PA than in those with EH, while the median myocardial perfusion reserve (MPR) [PA: 1.9 (IQR, 1.8-1.9); EH: 2.3 (IQR, 2.1-2.4); P<0.001] was lower. Both groups exhibited significant reductions in left ventricular mass, improvements in MPR, and decreases in extracellular volume (ECV) fraction following treatment. These changes were more pronounced in patients with PA than in those with the EH. Multivariate analysis showed that the baseline log plasma aldosterone-to-renin ratio (ARR) was an independent predictor of left ventricular mass, mass index, MPR, and ECV fraction, with beta values of 0.640, 0.658, -0.711, and 0.503, respectively.

CONCLUSIONS

Patients with PA and those with EH demonstrated improvements in ventricular remodeling posttreatment, with the former exhibiting a more substantial degree of recovery. LogARR was an independent predictor of left ventricular remodeling.