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Left atrial myocardial dysfunction in patients with primary aldosteronism as assessed by speckle-tracking echocardiography

Wang, Diana; Xu, Jian-Zhonga; Chen, Xinb; Xu, Ting-Yana; Zhang, Weia; Li, Yana; Wang, Ji-Guanga,b

doi: 10.1097/HJH.0000000000002146

Background: We investigated the left atrial myocardial deformation in patients with primary aldosteronism using the speckle-tracking echocardiographic (STE) strain imaging technique.

Methods: Our study included 107 primary aldosteronism patients [52 aldosterone-producing adenoma (APA) and 55 idiopathic hyperaldosteronism (IHA)] and 50 primary hypertensive patients. We performed conventional echocardiography to measure left atrial volume and ejection fraction, and STE to estimate left atrial myocardial deformation including peak velocity, strain and strain rate and calculate the ratio of E/e′ to left atrial strain during left ventricular systole as the left atrial stiffness index.

Results: Patients with APA, compared with those with IHA and primary hypertension had a significantly (P < 0.001) lower serum potassium concentration and higher 24-h urinary aldosterone excretion and plasma aldosterone-to-renin ratio. Patients with APA had a significantly (P < 0.01) larger maximal, precontraction, and minimal left atrial volumes and lower total, active and passive left atrial emptying fractions than those with IHA and primary hypertension. Among the three groups, patients with APA showed lowest left atrial velocity, strain, and strain rate during ventricular systole, early diastole and late diastole (P < 0.05) and highest left atrial stiffness index (P < 0.001). In unadjusted analysis, the left atrial strain, strain rate and stiffness index were significantly (P < 0.05) associated with plasma aldosterone concentration and urinary aldosterone excretion. After adjustment for various confounding factors, these associations remained statistically significant for urinary aldosterone excretion (P < 0.05) but not plasma aldosterone concentration (P ≥ 0.05).

Conclusion: Patients with primary aldosteronism, especially APA, had impaired left atrial deformation mechanics and increased left atrial stiffness, providing a promising insight into early detection of subclinical left atrial dysfunction by strain echocardiography.

aThe Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital

bDepartment of Hypertension, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China

Correspondence to Ji-Guang Wang, MD, PhD, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin 2nd Road 197, Shanghai 200025, China. E-mail:

Abbreviations: 2D-STE, two-dimensional speckle-tracking echocardiography; APA, aldosterone-producing adenoma; ARR, ratio of plasma aldosterone concentration to plasma renin activity; IHA, idiopathic hyperaldosteronism; PAC, plasma aldosterone concentration; PRA, plasma renin activity; STE, speckle-tracking echocardiography

Received 15 January, 2019

Revised 9 April, 2019

Accepted 12 April, 2019

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