Tohoku J. Exp. Med., 2023 February, 259(3)

Impact of Adrenalectomy on Diastolic Cardiac Dysfunction in Patients with Primary Aldosteronism

Kunihisa Nezu,¹ Yoshihide Kawasaki,¹ Ryo Morimoto,² Yoshikiyo Ono,² Kei Omata,² Yuta Tezuka,² Shuichi Shimada,¹ Youhei Satake,¹ Hiromichi Katayama,¹ Takuma Sato,¹ Naoki Kawamorita,¹ Shinichi Yamashita,¹ Hiroyuki Takahama,³ Koji Mitsuzuka,¹ Fumitoshi Satoh² and Akihiro Ito¹

¹Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
³Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

Poor prognostic cardiac function is known among some patients with primary aldosteronism (PA). However, studies with echocardiograms on whether the normalization of aldosterone after laparoscopic adrenalectomy (LADX) improves myocardial hypertrophy and diastolic cardiac dysfunction have been inadequate. Between August 2009 and December 2021, 147 patients with unilateral PA who underwent pre- and post-LADX echocardiography at a single center were enrolled in this retrospective study. We evaluated the cardiac impact of LADX by comparing patients who demonstrated complete clinical success (CS) with those who demonstrated partial or absent CS. Adjusted odds ratios (ORs) for not obtaining complete CS were calculated using binomial logistic regression analysis for clinically significant items among the pre-and postoperative clinical and echocardiographic markers. Overall, 47 (29%) and 104 (71%) patients had complete and partial or absent CS, respectively. Compared to patients with complete CS, patients with partial CS or without CS tended to have preoperative low early to late diastolic transmitral flow velocity (E/A) (< 0.8 cm/s) (41% vs. 21%, P < 0.05) and postoperative supranormal left ventricular ejection fraction (LVEF) (> 70%) (37% vs. 21%, P < 0.05). Furthermore, laparoscopic adrenalectomy improved the low and high echocardiographic values of E/A and LVEF, respectively, in both groups. The risk factors for not reaching complete CS were male sex (OR 3.42), low preoperative E/A (OR 3.11), and postoperative supranormal LVEF (OR 3.17). Although low preoperative E/A and postoperative supranormal LVEF are associated with poor clinical outcomes, LADX can improve diastolic cardiac function in patients with PA.

Keywords —— early to late diastolic transmitral flow velocity; echocardiography; laparoscopic adrenalectomy; primary aldosteronism; supranormal ejection fraction

© 2023 Tohoku University Medical Press

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Tohoku J. Exp. Med 2023, 259, 229-236.

Correspondence: Yoshihide Kawasaki, M.D., Ph.D., Department of Urology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: kawasaki@uro.med.tohoku.ac.jp