{"title":"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。","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":"{\"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. 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引用次数: 0
摘要
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。
Evaluating the effects of adrenalectomy and mineralocorticoid receptor antagonist on cardiac remodeling and diastolic function in patients with aldosterone-producing adenoma.
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.
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.