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Non-invasive left ventricular pressure-strain loop study on cardiac fibrosis in primary aldosteronism: a comparative study with cardiac magnetic resonance imaging

Hypertension Research volume 47, pages 445–454 (2024)Cite this article

Abstract

We investigated the potential diagnostic value of the myocardial work indices based on speckle tracking echocardiography for cardiac fibrosis in patients with primary aldosteronism. Our observational study included 48 patients with primary aldosteronism. We performed conventional echocardiography and the left ventricular pressure-strain loop analysis. We also performed cardiac magnetic resonance imaging to evaluate cardiac replacement fibrosis defined as late gadolinium enhancement (LGE). Patients with LGE (n = 30, 62.5%) had longer duration of hypertension and higher plasma NT-proBNP than those without LGE. Besides, they had a significantly (P ≤ 0.04) higher left ventricular mass index (121.3 ± 19.5 vs. 103.3 ± 20.0 g/m2) and global wasted work (205 ± 78 vs. 141 ± 36 mmHg%) and lower global longitudinal strain (−17.7 ± 1.8 vs. −19.0 ± 2.4%) and work efficiency (GWE, 90.9 ± 2.4 vs. 93.8 ± 1.5%). Receiver Operating Characteristics analysis showed that GWE ≤ 92% had a sensitivity and specificity of 76.7% and 83.3%, respectively, for LGE with the area under curve 0.85 (P < 0.001). In conclusion, both cardiac structure and function were impaired in patients with primary aldosteronism and cardiac fibrosis. The myocardial work index GWE showed significant value for the indication of cardiac fibrosis.

Characterization of cardiac fibrosis in primary aldosteronism and the detective value of clinical and echocardiographic indices. Cardiac fibrosis was presented in 30 of the 48 analyzed primary aldosteronism patients with focal high signal intensity in mid-layer myocardium in limited segments as its characterization. The global work efficiency (GWE) had a significantly higher detective value for myocardial replacement fibrosis than other measurements such as left ventricular mass index (LVMI) and NT-proBNP.

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Acknowledgements

The authors gratefully acknowledge the voluntary participation of all subjects.

Funding

The study investigators were financially supported by grants from the National Natural Science Foundation of China (82070432, 82070435, and 82270469) and Ministry of Science and Technology (grants 2018YFC1704902 and 2022YFC3601302), Beijing, China, and from the Shanghai Commissions of Science and Technology (grant 19DZ2340200 and 22S31905100), and Health (a special grant for “leading academics” 2022LJ022), Shanghai, China.

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  1. These authors contributed equally: Yi-Lin Chen, Chi-Hua Chen

Authors and Affiliations

  1. Department of Cardiovascular Medicine, National Research Center for Translational Medicine, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Yi-Lin Chen, Ting-Yan Xu, Jian-Zhong Xu, Li-Min Zhu, Yan Li & Ji-Guang Wang

  2. Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Chi-Hua Chen

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Chen, YL., Chen, CH., Xu, TY. et al. Non-invasive left ventricular pressure-strain loop study on cardiac fibrosis in primary aldosteronism: a comparative study with cardiac magnetic resonance imaging. Hypertens Res 47, 445–454 (2024). https://doi.org/10.1038/s41440-023-01482-w

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