Endocrine Abstracts

Introduction: Left ventricular hypertrophy (LVH) is associated with increased morbidity and mortality. LVH defined by ECG (ECG-LVH) has been evaluated using standard voltage criteria by Sokolow and Lyon (SL-LVH) and more recently using the Cornell product criteria (CP-LVH). Evaluation of CP-LVH is beneficial in hypertensive patients: however, in patients with primary aldosteronism (PA) whose incidence of cardiovascular events is higher than essential hypertension (EHT), there are no data on CP-LVH. Our aim was to show the higher rate of ECG-LVH, both CP-LVH and SL-LVH, in PA.

Methods: During a 10-year period, the diagnosis of PA was made in 127 patients. During the same period, clinical characteristics and ECG of this group were compared with those of 127 patients with EHT matched for age, gender, and blood pressure.

Results: The prevalence of CP-LVH was 38% for PA, 22% for EHT (odds ratio (OR) =2.1; 95% CI 1.2 to 3.6), and the prevalence of either CP-LVH or SL-LVH (CP/SL-LVH) was 54 and 34% (OR =2.2; 95% CI 1.3 to 3.7), respectively. However, the prevalence of SL-LVH was 29 and 23% (OR =1.3; 95% CI 0.75 to 2.3), respectively. The rate of ECG-LVH (CP-LVH, CP/SL-LVH, but not SL-LVH) increased with decreasing quartile of estimated GFR among PA (Cochran-Armitage P trend=0.0018, 0.0222), but not for EHT, indicating the strong ‘kidney–heart interaction’ in PA. In a multivariate logistic regression analysis, the presence of PA was an independent predictor of CP-LVH, CP/SL-LVH, but not for SL-LVH.

Conclusion: Patients with PA exhibit more CP-LVH than did EHT patients independent of blood pressure. CP-LVH clearly reveals the ‘kidney-heart interaction’ in PA. Thus, screening for CP-LVH to detect higher-risk patients should become a routine part of the evaluation of PA.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.