Demonstration of blood pressure-independent noninfarct myocardial fibrosis in primary aldosteronism: a cardiac magnetic resonance imaging study

Freel, E. M., Mark, P. B. , Weir, R. A.P., McQuarrie, E. P., Allan, K., Dargie, H. J., McClure, J. D. , Jardine, A. G. , Davies, E. and Connell, J. M.C. (2012) Demonstration of blood pressure-independent noninfarct myocardial fibrosis in primary aldosteronism: a cardiac magnetic resonance imaging study. Circulation: Cardiovascular Imaging, 5(6), pp. 740-747. (doi:10.1161/CIRCIMAGING.112.974576)

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Publisher's URL: http://dx.doi.org/10.1161/CIRCIMAGING.112.974576

Abstract

<p>Background—Primary Aldosteronism (PA) is common and associates with excess cardiovascular morbidity independent of blood pressure. Exposure to aldosterone and sodium leads to cardiac fibrosis and hypertrophy in humans and animals possibly mediated by inflammation and oxidative stress. We aimed to clarify the effects of aldosterone excess on myocardial structure and composition in human subjects with PA and essential hypertension (EH) using contrast-enhanced cardiac MRI (CMR) as well as explore the mechanistic basis for any observed differences.</p> <p>Methods and Results—Twenty seven subjects with recently diagnosed PA and 54 EH controls were recruited. Subjects underwent gadolinium-enhanced CMR; non-infarct related myocardial fibrosis was identified by a diffuse pattern of late gadolinium enhancement (LGE). Patients also underwent assessment of pulse wave velocity (PWV), measurement of circulating superoxide anion and C-reactive protein as well as blood pressure and biochemical assessment. Subjects were well matched with no difference in severity nor duration of hypertension. There was a significant increase in the frequency of non-infarct LGE in PA (70%) when compared to EH subjects (13%; p<0.0001) with no difference in LV mass. PWV, superoxide and CRP were significantly higher in PA subjects.</p> <p>Conclusions—These data illustrate that PA patients exhibit more frequent myocardial fibrosis as demonstrated by LGE using CMR imaging; this finding is independent of blood pressure. This may be mediated partly through inflammation and oxidative stress. This study highlights the importance of specific targeting of aldosterone excess as well as blood pressure reduction to minimise cardiac morbidity in Primary Aldosteronism.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Allan, Miss Karen and Mark, Dr Patrick and McQuarrie, Dr Emily and Dargie, Professor Henry and Davies, Professor Eleanor and Connell, Professor John and Freel, Dr Marie and Jardine, Professor Alan and McClure, Dr John
Authors: Freel, E. M., Mark, P. B., Weir, R. A.P., McQuarrie, E. P., Allan, K., Dargie, H. J., McClure, J. D., Jardine, A. G., Davies, E., and Connell, J. M.C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation: Cardiovascular Imaging
Publisher:American Heart Association
ISSN:1941-9651
ISSN (Online):1942-0080
Published Online:27 September 2012
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
496251Translational studies on the role of corticosteroids in cardiovascular diseaseMarie FreelMedical Research Council (MRC)G0802803RI CARDIOVASCULAR & MEDICAL SCIENCES
496252Translational studies on the role of corticosteroids in cardiovascular diseaseMarie FreelMedical Research Council (MRC)G0802803RI CARDIOVASCULAR & MEDICAL SCIENCES