Evaluating the effects of adrenalectomy and mineralocorticoid receptor antagonist on cardiac remodeling and diastolic function in patients with aldosterone-producing adenoma.

IF 4.3 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Hypertension Research Pub Date : 2024-10-25 DOI:10.1038/s41440-024-01946-7
Yu-Ching Chang, Xue-Ming Wu, Tsung-Yan Chen, Uei-Lin Chen, Che-Wei Liao, Tai-Shuan Lai, Chin-Chen Chang, Bo-Ching Lee, Fang-Yu Yang, Zheng-Wei Chen, Yi-Yao Chang, Jeff S Chueh, Vin-Cent Wu, Cheng-Hsuan Tsai, Chi-Sheng Hung, Yen-Hung Lin
{"title":"Evaluating the effects of adrenalectomy and mineralocorticoid receptor antagonist on cardiac remodeling and diastolic function in patients with aldosterone-producing adenoma.","authors":"Yu-Ching Chang, Xue-Ming Wu, Tsung-Yan Chen, Uei-Lin Chen, Che-Wei Liao, Tai-Shuan Lai, Chin-Chen Chang, Bo-Ching Lee, Fang-Yu Yang, Zheng-Wei Chen, Yi-Yao Chang, Jeff S Chueh, Vin-Cent Wu, Cheng-Hsuan Tsai, Chi-Sheng Hung, Yen-Hung Lin","doi":"10.1038/s41440-024-01946-7","DOIUrl":null,"url":null,"abstract":"<p><p>Cardiac remodeling and diastolic dysfunction in patients with aldosterone-producing adenomas (APA) can be improved after adrenalectomy. However, the effect of mineralocorticoid receptor antagonist (MRA) treatment remains unclear. The aim of this study is to evaluate the effect of MRA on cardiac remodeling and diastolic dysfunction in patients with PA. We prospectively enrolled patients with APA from 1993 to 2023, who either received medical treatment with MRAs or underwent adrenalectomy. Biochemical characteristics and echocardiographic findings were collected at baseline and one year after treatment. Propensity score matching was conducted based on baseline biochemical characteristics, left ventricular mass index (LVMI), and diastolic function. A total of 467 APA patients were enrolled in the study. After propensity score matching, 159 patients who underwent adrenalectomy were matched with 159 patients who received MRAs. After therapy, patients who received MRAs showed significant improvement in diastolic function after one year of treatment but not LVMI. Compared to the MRA group, the adrenalectomy group had greater improvement in systolic blood pressure, plasma aldosterone concentration, plasma renin activity, aldosterone-to-renin ratio, and LVMI. In multivariable regression analysis, pretreatment echocardiographic values were significantly associated with changes in both LVMI and E/e', while the treatment strategy showed a significant association with changes in LVMI. Thus, one year after therapy, both adrenalectomy and MRA are effective in improving diastolic function in patients with APA. However, adrenalectomy is more effective than MRA treatment in reversing cardiac remodeling in patients with APA.</p>","PeriodicalId":13029,"journal":{"name":"Hypertension Research","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hypertension Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41440-024-01946-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0

Abstract

Cardiac remodeling and diastolic dysfunction in patients with aldosterone-producing adenomas (APA) can be improved after adrenalectomy. However, the effect of mineralocorticoid receptor antagonist (MRA) treatment remains unclear. The aim of this study is to evaluate the effect of MRA on cardiac remodeling and diastolic dysfunction in patients with PA. We prospectively enrolled patients with APA from 1993 to 2023, who either received medical treatment with MRAs or underwent adrenalectomy. Biochemical characteristics and echocardiographic findings were collected at baseline and one year after treatment. Propensity score matching was conducted based on baseline biochemical characteristics, left ventricular mass index (LVMI), and diastolic function. A total of 467 APA patients were enrolled in the study. After propensity score matching, 159 patients who underwent adrenalectomy were matched with 159 patients who received MRAs. After therapy, patients who received MRAs showed significant improvement in diastolic function after one year of treatment but not LVMI. Compared to the MRA group, the adrenalectomy group had greater improvement in systolic blood pressure, plasma aldosterone concentration, plasma renin activity, aldosterone-to-renin ratio, and LVMI. In multivariable regression analysis, pretreatment echocardiographic values were significantly associated with changes in both LVMI and E/e', while the treatment strategy showed a significant association with changes in LVMI. Thus, one year after therapy, both adrenalectomy and MRA are effective in improving diastolic function in patients with APA. However, adrenalectomy is more effective than MRA treatment in reversing cardiac remodeling in patients with APA.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
评估肾上腺切除术和矿质皮质激素受体拮抗剂对醛固酮腺瘤患者心脏重塑和舒张功能的影响。
肾上腺切除术后,醛固酮腺瘤(APA)患者的心脏重塑和舒张功能障碍可得到改善。然而,矿物皮质激素受体拮抗剂(MRA)治疗的效果仍不明确。本研究旨在评估 MRA 对 PA 患者心脏重塑和舒张功能障碍的影响。我们前瞻性地纳入了 1993 年至 2023 年期间接受 MRA 药物治疗或肾上腺切除术的 APA 患者。我们收集了基线和治疗一年后的生化特征和超声心动图结果。根据基线生化特征、左心室质量指数(LVMI)和舒张功能进行倾向得分匹配。共有 467 名 APA 患者参与了研究。经过倾向评分匹配后,159 名接受肾上腺切除术的患者与 159 名接受 MRA 的患者相匹配。接受 MRA 治疗的患者在治疗一年后舒张功能明显改善,但 LVMI 没有改善。与 MRA 组相比,肾上腺切除术组在收缩压、血浆醛固酮浓度、血浆肾素活性、醛固酮-肾素比值和 LVMI 方面的改善幅度更大。在多变量回归分析中,治疗前的超声心动图值与 LVMI 和 E/e' 的变化有显著相关性,而治疗策略与 LVMI 的变化有显著相关性。因此,治疗一年后,肾上腺切除术和 MRA 都能有效改善 APA 患者的舒张功能。然而,在逆转 APA 患者心脏重塑方面,肾上腺切除术比 MRA 治疗更有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Hypertension Research
Hypertension Research 医学-外周血管病
CiteScore
7.40
自引率
16.70%
发文量
249
审稿时长
3-8 weeks
期刊介绍: Hypertension Research is the official publication of the Japanese Society of Hypertension. The journal publishes papers reporting original clinical and experimental research that contribute to the advancement of knowledge in the field of hypertension and related cardiovascular diseases. The journal publishes Review Articles, Articles, Correspondence and Comments.
期刊最新文献
Asian hypertensive population: key insights from large-scale data analysis Association between urinary cotinine level and hypertensive disorders of pregnancy in women with uterine myoma: findings from the Japan Environment and Children's Study. Differences in the effects of exercise on blood pressure depending on the physical condition of the subject and the type of exercise: a systematic review and meta-analysis. Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy - a retrospective register-based study. Prevention of atherosclerotic cerebro-cardiovascular disease: a key objective in blood pressure management for coronary artery disease in East Asia.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1