Int J Med Sci 2015; 12(5):369-377. doi:10.7150/ijms.10975
The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism
1. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan;
2. Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan;
3. Department of Medical Image, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan;
4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan;
5. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine. Taipei, Taiwan;
6. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Background: Glomerular hyperfiltration has been recently noticed as an important issue in primary aldosteronism (PA) patients. However, its effect on the cardiovascular system remains unknown.
Methods: We prospectively analyzed 47 PA patients including 11 PA patients with estimated glomerular filtration rate (eGFR) > 130 ml/min per 1.73 m2 (group 1), and 36 PA patients with eGFR 90-110 ml/min per 1.73 m2 (group 2). Fourteen essential hypertension (EH) patients with eGFR 90-110 ml/min per 1.73 m2 were included as the control group (group 3). Echocardiography including left ventricular mass index (LVMI) measurement and tissue Doppler imaging (TDI) was performed. Predicted left ventricular mass (LVM) was calculated. Inappropriate LVM was defined as an excess of > 35% from the predicted value.
Results: The value of LVMI decreased significantly in order from groups 1 to 3 (group 1>2>3). While group 2 had a significantly higher percentage of inappropriate LVM than group 3, the percentage of inappropriate LVM were comparable in groups 1 and 2. Group 1 had a higher mitral E velocity, E/A ratio than that of group 2. In the TDI study, the E/E' ratio also decreased significantly in order from groups 1 to 3 (group 1>2>3). Group 2 had lower E' than that of group 3, although the E' of group 1 and 2 were comparable.
Conclusions: Although PA patients with glomerular hyperfiltration were associated with higher LVMI, higher mitral E velocity, higher E/E' ratio, they had comparable E' with PA patients with normal GFR. This phenomenon may be explained by higher intravascular volume in this patient group.
Keywords: Primary aldosteronism, Glomerular hyperfiltration, Left ventricular hypertrophy.
Liao MT, Wu XM, Chang CC, Liao CW, Chen YH, Lu CC, Lin YT, Chang YY, Hung CS, Lin LC, Lai CL, Lin LY, Wu VC, Ho YL, Wu KD, Lin YH,