Presentation Authors: Yoshihide Kawasaki*, Shigeto Ishidoya, Yasuhiro Kaiho, Shuichi Shimada, Tomonori Sato, Shinichi Yamashita, Koji Mitsuzuka, Akihiro Ito, Sendai, Japan
Introduction: A major target of aldosterone is the distal tubule of the kidney, acting through mineralocorticoid receptors (MRs) on the epithelial cells of the renal tubules. MRs have recently been reported to exist in vascular endothelium and cardiac muscle, meaning that aldosterone would also act directly on those organs and potentially provoke cardiovascular pathologies. This study therefore evaluated the incidence of cardiac hypofunction and low ejection fraction (EF) among patients with primary aldosteronism (PA), and the influence of laparoscopic adrenalectomy (LADX) on improvement of EF in patients with PA.
Methods: We retrospectively investigated patients who underwent LADX for unilateral PA in our hospital between August 2008 and July 2017. Background characteristics, perioperative blood biochemical data and echocardiographic data were evaluated to elucidate incidence of low EF ( < 60%) and factors contributing to low EF among PA patients. EF was determined by echocardiogram as: EF = stroke volume (left ventricular end-diastolic dimension - left ventricular end-systolic dimension) Ã· left ventricular end-diastolic dimension.
Results: Among the 241 patients who underwent LADX for unilateral PA during the study period, we identified 24 (10%) with low EF. Median age was 53 years, and 19 were male (79%). Median EF improved significantly from 54% (range, 20.8-59%) to 67% (range, 50-71%) after LADX (P < 0.0012). As a reason for this improvement, increased left ventricular end-diastolic dimension was demonstrated on echocardiography in all of 24 patients after LADX (Table). Univariate analysis indicated that male sex and excessive serum aldosterone were important factors contributing to preoperative low EF in PA patients. Normalization of serum aldosterone appeared to improve cardiac function in PA patients, because all patients with low EF had been taking anti-MR agents such as spironolactone and/or eplerenone preoperatively.
Conclusions: Our results suggested that excessive serum aldosterone could contribute to low EF, especially among male patients with PA. However, we found that the improvement of cardiac function in those patients is achieved by LADX to normalize serum aldosterone.