Demonstration of Blood Pressure-Independent Non Infarct Myocardial Fibrosis in Primary Aldosteronism: A Cardiac MRI Study

Study Questions:

Do patients with primary aldosteronism (PA) have differences in myocardial fibrosis and mass in comparison to individuals with essential hypertension (EH)?

Methods:

This study evaluated 27 individuals with newly diagnosed PA and 54 control patients with EH matched for age, gender, and duration and severity of hypertension. Contrast-enhanced magnetic resonance (CMR) imaging was utilized to compare left ventricular size, mass, and fibrosis by late gadolinium enhancement (LGE). One patient with PA did not complete the CMR, two patients with PA declined gadolinium contrast, and seven with EH had artifact that precluded assessment of LGE.

Results:

The cohorts were well matched by age, gender, blood pressure, and hypertension duration, with no significant differences between groups. Between PA and EH individuals, there were no differences in left ventricular mass (135 vs. 128 g, p = 0.2), end-diastolic volume (123 vs. 132 ml, p = 0.2), or stroke volume (94 vs. 91 ml, p = 0.6). After excluding three individuals with an LGE pattern of prior myocardial infarction, LGE was observed more frequently in those with PA, as compared to controls with EH (70% vs. 13%, p < 0.001).

Conclusions:

Individuals with PA are more likely to have myocardial fibrosis, as compared to matched controls with EH.

Perspective:

PA is a relatively common cause of hypertension, and is associated with an increased risk of adverse cardiovascular events. This study compares PA to a well-matched cohort with EH and comparable severity and duration of hypertension. Despite a similar hypertension burden, the PA cohort had a more than fivefold increase in the prevalence of myocardial fibrosis, suggesting a blood pressure-independent effect of PA on myocardial structure. These findings support the need for prompt identification and treatment of PA.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Magnetic Resonance Imaging, Hypertension

Keywords: Prevalence, Myocardial Infarction, Hyperaldosteronism, Cardiomyopathies, Gadolinium, Cardiovascular Diseases, Stroke Volume, Magnetic Resonance Spectroscopy, Fibrosis, Magnetic Resonance Imaging, Hypertension, Artifacts


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