Demonstration of Blood Pressure-Independent Noninfarct Myocardial Fibrosis in Primary Aldosteronism: A Cardiac Magnetic Resonance Imaging Study

E. Marie Freel, Patrick B. Mark, Robin A. P. Weir, Emily P. McQuarrie, Karen Allan, Henry J. Dargie, John D. McClure, Alan G. Jardine, Eleanor Davies, John M. C. Connell

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    Abstract

    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 using contrast-enhanced cardiac magnetic resonance imaging as well as explore the mechanistic basis for any observed differences.

    Methods and Results-Twenty-seven subjects with recently diagnosed PA and 54 essential hypertension controls were recruited. Subjects underwent gadolinium-enhanced cardiac magnetic resonance; noninfarct related myocardial fibrosis was identified by a diffuse pattern of late gadolinium enhancement. Patients also underwent assessment of pulse wave velocity, 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 or duration of hypertension. There was a significant increase in the frequency of noninfarct late gadolinium enhancement in PA (70%) when compared with essential hypertension subjects (13%; P

    Conclusions-These data illustrate that patients with PA exhibit frequent myocardial fibrosis as demonstrated by late gadolinium enhancement using cardiac magnetic resonance 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 minimize cardiac morbidity in PA. (Circ Cardiovasc Imaging. 2012;5:740-747.)

    Original languageEnglish
    Pages (from-to)740-747
    Number of pages8
    JournalCirculation - Cardiovascular Imaging
    Volume5
    Issue number6
    DOIs
    Publication statusPublished - Nov 2012

    Keywords

    • PATHOLOGICAL HYPERTROPHY
    • PULSE-WAVE VELOCITY
    • SALT
    • primary aldosteronism
    • aldosterone
    • HEART-FAILURE
    • HYPERALDOSTERONISM
    • RAT
    • HYPERTENSIVE PATIENTS
    • RESISTANT HYPERTENSION
    • hypertension
    • fibrosis
    • LEFT-VENTRICULAR HYPERTROPHY
    • cardiac magnetic resonance imaging
    • RENOVASCULAR HYPERTENSION

    Cite this

    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., & 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), 740-747. https://doi.org/10.1161/CIRCIMAGING.112.974576