Download PDF
Horm Metab Res 2020; 52(06): 357-365
DOI: 10.1055/a-1141-5989
Review

Atrial Fibrillation in Primary Aldosteronism

Chien-Ting Pan
1   Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
,
Cheng-Hsuan Tsai
2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
3   Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
,
Zheng-Wei Chen
1   Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
,
Yi-Yao Chang
4   Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
,
Vin-Cent Wu
5   Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
,
Chi-Sheng Hung
2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
6   Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
,
Yen-Hung Lin
2   Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
6   Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
,
the TAIPAI Study Group › Author Affiliations Funding: This research was supported by grants from the Ministry of Science and Technology (MOST 106–2314-B-002–048 –MY3 and MOST 106–2314-B-002–169-MY3) and National Taiwan University Hospital (NTUH 107-A141).
› Further Information
Also available at
   Permissions and Reprints

Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension. Increasing evidence has demonstrated an increased cardiovascular risk in patients with PA compared to those with essential hypertension (EH), including atrial fibrillation (AF), the most prevalent arrhythmia among adults that is associated with an elevated risk of subsequent cerebro-cardiovascular adverse events. The mechanisms of increased prevalence of AF in PA patients are complex. Excessive aldosterone production is regarded to be a key component in the pathogenesis of AF, in addition to arterial hypertension and electrolyte imbalance. In addition, several translational and clinical studies have reported that structural remodeling with atrial fibrosis and electrical remodeling with arrhythmogenicity induced by an excess of aldosterone also play major roles in AF genesis. Clinical studies from several registries and meta-analysis have reported an increased prevalence and risk of AF in PA patients compared to EH patients. Recent trials have further demonstrated a reduction in the risk of new-onset atrial fibrillation (NOAF) after adrenalectomy, while the results of medical treatment with mineralocorticoid receptor antagonists (MRAs) have been inconsistent. This review outlines the current evidence of the relationship between PA and AF, and highlights recent progress in the management of PA with regards to the development of AF.

Key words

atrial fibrillation - primary aldosteronism - aldosterone - atrial remodeling


Publication History

Received: 16 December 2019

Accepted: 09 March 2020

Article published online:
14 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Funder JW, Carey RM, Mantero F. et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
    CrossrefPubMedGoogle Scholar
  • 2 Milliez P, Girerd X, Plouin PF. et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-1248
    CrossrefPubMedGoogle Scholar
  • 3 Monticone S, D’Ascenzo F, Moretti C. et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018; 6: 41-50
    CrossrefPubMedGoogle Scholar
  • 4 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50: e1-e88
    CrossrefPubMedGoogle Scholar
  • 5 Born-Frontsberg E, Reincke M, Rump LC. et al. Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn’s Registry. J Clin Endocrinol Metab 2009; 94: 1125-1130
    CrossrefPubMedGoogle Scholar
  • 6 Staerk L, Sherer JA, Ko D. et al. Atrial fibrillation: epidemiology. pathophysiology, and clinical outcomes. Circul Res 2017; 120: 1501-1517
    PubMedGoogle Scholar
  • 7 Hirsh BJ, Copeland-Halperin RS, Halperin JL. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences. J Am Coll Cardiol 2015; 65: 2239-2251
    CrossrefPubMedGoogle Scholar
  • 8 Gravez B, Tarjus A, Jaisser F. Mineralocorticoid receptor and cardiac arrhythmia. Clin Exp Pharmacol Physiol 2013; 40: 910-915
    CrossrefPubMedGoogle Scholar
  • 9 Haissaguerre M, Jais P, Shah DC. et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Eng J Med 1998; 339: 659-666
    CrossrefPubMedGoogle Scholar
  • 10 Hove-Madsen L, Llach A, Bayes-Genis A. et al. Atrial fibrillation is associated with increased spontaneous calcium release from the sarcoplasmic reticulum in human atrial myocytes. Circulation 2004; 110: 1358-1363
    CrossrefPubMedGoogle Scholar
  • 11 Burstein B, Libby E, Calderone A. et al. Differential behaviors of atrial versus ventricular fibroblasts: a potential role for platelet-derived growth factor in atrial-ventricular remodeling differences. Circulation 2008; 117: 1630-1641
    CrossrefPubMedGoogle Scholar
  • 12 Rossi GP, Sacchetto A, Visentin P. et al. Changes in left ventricular anatomy and function in hypertension and primary aldosteronism. Hypertension 1996; 27: 1039-1045
    CrossrefPubMedGoogle Scholar
  • 13 Kozakova M, Buralli S, Palombo C. et al. Myocardial ultrasonic backscatter in hypertension: relation to aldosterone and endothelin. Hypertension 2003; 41: 230-236
    CrossrefPubMedGoogle Scholar
  • 14 Fiebeler A, Schmidt F, Muller DN. et al. Mineralocorticoid receptor affects AP-1 and nuclear factor-kappab activation in angiotensin II-induced cardiac injury. Hypertension 2001; 37 787-793
    CrossrefPubMedGoogle Scholar
  • 15 Keidar S, Kaplan M, Pavlotzky E. et al. Aldosterone administration to mice stimulates macrophage NADPH oxidase and increases atherosclerosis development: a possible role for angiotensin-converting enzyme and the receptors for angiotensin II and aldosterone. Circulation 2004; 109: 2213-2220
    CrossrefPubMedGoogle Scholar
  • 16 Sun Y, Zhang J, Lu L. et al. Aldosterone-induced inflammation in the rat heart: role of oxidative stress. Am J Pathol 2002; 161: 1773-1781
    CrossrefPubMedGoogle Scholar
  • 17 Yoshida K, Kim-Mitsuyama S, Wake R. et al. Excess aldosterone under normal salt diet induces cardiac hypertrophy and infiltration via oxidative stress. Hypertens Res 2005; 28: 447-455
    CrossrefPubMedGoogle Scholar
  • 18 Shen JZ, Morgan J, Tesch GH. et al. Cardiac tissue injury and remodeling is dependent upon mr regulation of activation pathways in cardiac tissue macrophages. Endocrinology 2016; 157: 3213-3223
    CrossrefPubMedGoogle Scholar
  • 19 Usher MG, Duan SZ, Ivaschenko CY. et al. Myeloid mineralocorticoid receptor controls macrophage polarization and cardiovascular hypertrophy and remodeling in mice. J Clin Invest 2010; 120: 3350-3364
    CrossrefPubMedGoogle Scholar
  • 20 Oestreicher EM, Martinez-Vasquez D, Stone JR. et al. Aldosterone and not plasminogen activator inhibitor-1 is a critical mediator of early angiotensin II/NG-nitro-L-arginine methyl ester-induced myocardial injury. Circulation 2003; 108: 2517-2523
    CrossrefPubMedGoogle Scholar
  • 21 Desmouliere A, Geinoz A, Gabbiani F. et al. Transforming growth factor-beta 1 induces alpha-smooth muscle actin expression in granulation tissue myofibroblasts and in quiescent and growing cultured fibroblasts. J Cell Biol 1993; 122: 103-111
    CrossrefPubMedGoogle Scholar
  • 22 Baum J, Duffy HS. Fibroblasts and myofibroblasts: what are we talking about?. J Cardiovasc Pharmacol 2011; 57: 376-379
    CrossrefPubMedGoogle Scholar
  • 23 Yang Y, Chen S, Tao L. et al. Inhibitory effects of oxymatrine on transdifferentiation of neonatal rat cardiac fibroblasts to myofibroblasts induced by aldosterone via Keap1/Nrf2 signaling pathways in vitro. Med Sci Monit 2019; 25: 5375-5388
    CrossrefPubMedGoogle Scholar
  • 24 Sun Y, Ramires FJ, Weber KT. Fibrosis of atria and great vessels in response to angiotensin II or aldosterone infusion. Cardiovasc Res 1997; 35: 138-147
    CrossrefPubMedGoogle Scholar
  • 25 Reil JC, Hohl M, Selejan S. et al. Aldosterone promotes atrial fibrillation. Eur Heart J 2012; 33: 2098-2108
    CrossrefPubMedGoogle Scholar
  • 26 Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ Arrhyth Electrophysiol 2008; 1: 62-73
    CrossrefPubMedGoogle Scholar
  • 27 Heijman J, Voigt N, Nattel S. et al. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res 2014; 114: 1483-1499
    CrossrefPubMedGoogle Scholar
  • 28 Lammers C, Dartsch T, Brandt MC. et al. Spironolactone prevents aldosterone induced increased duration of atrial fibrillation in rat. Cell Physiol Biochem 2012; 29: 833-840
    CrossrefPubMedGoogle Scholar
  • 29 Agarwal YK, Aronow WS, Levy JA. et al. Association of interatrial block with development of atrial fibrillation. Am J Cardiol 2003; 91: 882
    CrossrefPubMedGoogle Scholar
  • 30 Magnani JW, Johnson VM, Sullivan LM. et al. P wave duration and risk of longitudinal atrial fibrillation in persons >/= 60 years old (from the Framingham Heart Study). Am J Cardiol 2011; 107: 917-921 e911
    CrossrefPubMedGoogle Scholar
  • 31 Ouvrard-Pascaud A, Sainte-Marie Y, Benitah JP. et al. Conditional mineralocorticoid receptor expression in the heart leads to life-threatening arrhythmias. Circulation 2005; 111: 3025-3033
    CrossrefPubMedGoogle Scholar
  • 32 Gomez AM, Rueda A, Sainte-Marie Y. et al. Mineralocorticoid modulation of cardiac ryanodine receptor activity is associated with downregulation of FK506-binding proteins. Circulation 2009; 119: 2179-2187
    CrossrefPubMedGoogle Scholar
  • 33 Tsai CT, Chiang FT, Tseng CD. et al. Increased expression of mineralocorticoid receptor in human atrial fibrillation and a cellular model of atrial fibrillation. J Am Coll Cardiol 2010; 55: 758-770
    CrossrefPubMedGoogle Scholar
  • 34 Seidel E, Schewe J, Scholl UI. Genetic causes of primary aldosteronism. Exp Mol Med 2019; 51: 131
    PubMedGoogle Scholar
  • 35 Amin AS, Wilde AAM. Inheritable potassium channel diseases. In cardiac electrophysiology: from cell to bedside. Amsterdam: Elsevier, Inc; 2018: 494-503
    Google Scholar
  • 36 Jabbari J, Olesen MS, Holst AG. et al. Common polymorphisms in KCNJ5 [corrected] are associated with early-onset lone atrial fibrillation in Caucasians. Cardiology 2011; 118: 116-120
    CrossrefPubMedGoogle Scholar
  • 37 Yamada N, Asano Y, Fujita M. et al. Mutant KCNJ3 and KCNJ5 potassium channels as novel molecular targets in bradyarrhythmias and atrial fibrillation. Circulation 2019; 139: 2157-2169
    CrossrefPubMedGoogle Scholar
  • 38 Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther 2016; 14: 915-926
    CrossrefPubMedGoogle Scholar
  • 39 Nadruz W, Shah AM, Solomon SD. Diastolic dysfunction and hypertension. Med Clin North Am 2017; 101: 7-17
    CrossrefPubMedGoogle Scholar
  • 40 Lau DH, Nattel S, Kalman JM. et al. Modifiable risk factors and atrial fibrillation. Circulation 2017; 136: 583-596
    CrossrefPubMedGoogle Scholar
  • 41 Rosenberg MA, Manning WJ. Diastolic dysfunction and risk of atrial fibrillation: a mechanistic appraisal. Circulation 2012; 126: 2353-2362
    CrossrefPubMedGoogle Scholar
  • 42 Kistler PM, Sanders P, Dodic M. et al. Atrial electrical and structural abnormalities in an ovine model of chronic blood pressure elevation after prenatal corticosteroid exposure: implications for development of atrial fibrillation. Eur Heart J 2006; 27: 3045-3056
    CrossrefPubMedGoogle Scholar
  • 43 Vaziri SM, Larson MG, Lauer MS. et al. Influence of blood pressure on left atrial size. The framingham heart study. Hypertension 1995; 25: 1155-1160
    CrossrefPubMedGoogle Scholar
  • 44 Henry WL, Morganroth J, Pearlman AS. et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 1976; 53: 273-279
    CrossrefPubMedGoogle Scholar
  • 45 Kannel WB, Wolf PA, Benjamin EJ. et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998; 82 2n-9n
    CrossrefPubMedGoogle Scholar
  • 46 Al-Aloul B, Li JM, Benditt D. et al. Atrial fibrillation associated with hypokalemia due to primary hyperaldosteronism (Conn's syndrome). Pacing Clin Electrophysiol 2006; 29: 1303-1305
    CrossrefPubMedGoogle Scholar
  • 47 Watson T, Karthikeyan VJ, Lip GY. et al. Atrial fibrillation in primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2009; 10: 190-194
    CrossrefPubMedGoogle Scholar
  • 48 Krijthe BP, Heeringa J, Kors JA. et al Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study. Int J Cardiol 2013; 168: 5411-5415
    CrossrefPubMedGoogle Scholar
  • 49 Auer J, Weber T, Berent R. et al. Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery. J Am Coll Cardiol 2004; 44: 938-939
    CrossrefPubMedGoogle Scholar
  • 50 Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia. Circ Arrhyth Electrophysiol 2017; 10 pii e004667 DOI: 10.1161/CIRCEP.116.004667.
    CrossrefPubMedGoogle Scholar
  • 51 Catena C, Colussi G, Nadalini E. et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008; 168: 80-85
    CrossrefPubMedGoogle Scholar
  • 52 Savard S, Amar L, Plouin PF. et al. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 2013; 62: 331-336
    CrossrefPubMedGoogle Scholar
  • 53 Mulatero P, Monticone S, Bertello C. et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013; 98: 4826-4833
    CrossrefPubMedGoogle Scholar
  • 54 Ohno Y, Sone M, Inagaki N. et al. Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter study in Japan. Hypertension 2018; 71: 530-537
    CrossrefPubMedGoogle Scholar
  • 55 Mourtzinis G, Ebrahimi A, Gustafsson H. et al. Aldosterone to renin ratio as a screening instrument for primary aldosteronism in a middle-aged population with atrial fibrillation. Horm Metab Res 2017; 49: 831-837
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Mourtzinis G, Adamsson Eryd S, Rosengren A. et al. Primary aldosteronism and thyroid disorders in atrial fibrillation: a Swedish nationwide case-control study.. Eur J Prev Cardiol 2018; 25: 694-701
    CrossrefPubMedGoogle Scholar
  • 57 Seccia TM, Letizia C, Muiesan ML. et al. Atrial fibrillation as presenting sign of primary aldosteronism: results of the prospective appraisal on the prevalence of primary aldosteronism in hypertensive (PAPPHY) study. J Hypertens 2020; 38: 332-339
    CrossrefPubMedGoogle Scholar
  • 58 Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol 2014; 63: 493-505
    CrossrefPubMedGoogle Scholar
  • 59 Nagueh SF, Smiseth OA, Appleton CP. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 2016; 29: 277-314
    CrossrefPubMedGoogle Scholar
  • 60 Yang Y, Zhu LM, Xu JZ. et al. Comparison of left ventricular structure and function in primary aldosteronism and essential hypertension by echocardiography. Hypertens Res 2017; 40: 243-250
    CrossrefPubMedGoogle Scholar
  • 61 Chen ZW, Huang KC, Lee JK. et al. Aldosterone induces left ventricular subclinical systolic dysfunction: a strain imaging study. J Hypertens 2018; 36: 353-360
    CrossrefPubMedGoogle Scholar
  • 62 Wang D, Xu JZ, Chen X. et al. Left atrial myocardial dysfunction in patients with primary aldosteronism as assessed by speckle-tracking echocardiography. J Hypertens 2019; 37: 2032-2040
    CrossrefPubMedGoogle Scholar
  • 63 Stowasser M, Sharman J, Leano R. et al. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J Clin Endocrinol Metab 2005; 90: 5070-5076
    CrossrefPubMedGoogle Scholar
  • 64 Catena C, Colussi G, Lapenna R. et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007; 50: 911-918
    CrossrefPubMedGoogle Scholar
  • 65 Muiesan ML, Salvetti M, Paini A. et al. Inappropriate left ventricular mass in patients with primary aldosteronism. Hypertension 2008; 52: 529-534
    CrossrefPubMedGoogle Scholar
  • 66 Cesari M, Letizia C, Angeli P. et al. Cardiac remodeling in patients with primary and secondary aldosteronism: a tissue doppler study. Circ Cardiovasc Imaging 2016; 9 e004815 DOI: 10.1161/CIRCIMAGING.116.004815.
    CrossrefPubMedGoogle Scholar
  • 67 Lin YH, Huang KH, Lee JK. et al. Factors influencing left ventricular mass regression in patients with primary aldosteronism post adrenalectomy. J Renin Angiotensin Aldosterone Syst 2011; 12: 48-53
    CrossrefPubMedGoogle Scholar
  • 68 Hung CS, Ho YL, Chang YY. et al. Twenty-four-hour urinary aldosterone predicts inappropriate left ventricular mass index in patients with primary aldosteronism. Sci World J. 2013: 294594
    PubMedGoogle Scholar
  • 69 Chang YY, Lee HH, Hung CS. et al. Association between urine aldosterone and diastolic function in patients with primary aldosteronism and essential hypertension. Clin Biochem 2014; 47: 1329-1332
    CrossrefPubMedGoogle Scholar
  • 70 Kontak AC, Wang Z, Arbique D. et al. Reversible sympathetic overactivity in hypertensive patients with primary aldosteronism. J Clin Endocrinol Metab 2010; 95: 4756-4761
    CrossrefPubMedGoogle Scholar
  • 71 Khan AA, Lip GYH, Shantsila A. Heart rate variability in atrial fibrillation: the balance between sympathetic and parasympathetic nervous system. Eur J Clin Invest 2019; 49: e13174
    PubMedGoogle Scholar
  • 72 Perkiomaki J, Ukkola O, Kiviniemi A. et al. Heart rate variability findings as a predictor of atrial fibrillation in middle-aged population. J Cardiovasc Electrophysiol 2014; 25: 719-724
    PubMedGoogle Scholar
  • 73 Friedman HS. Heart rate variability in atrial fibrillation related to left atrial size. Am J Cardiol 2004; 93: 705-709
    CrossrefPubMedGoogle Scholar
  • 74 Agarwal SK, Norby FL, Whitsel EA. et al. Cardiac autonomic dysfunction and incidence of atrial fibrillation: results from 20 years follow-up. J Am Coll Cardiol 2017; 69: 291-299
    PubMedGoogle Scholar
  • 75 Veglio F, Melchio R, Rabbia F. et al. Spectral characteristics of heart rate and blood pressure variability in primary aldosteronism. Am J Hypertens 1995; 8 479-486
    CrossrefPubMedGoogle Scholar
  • 76 Lin YH, Wu VC, Lo MT. et al. Reversible heart rhythm complexity impairment in patients with primary aldosteronism. Sci Rep 2015; 5: 11249
    CrossrefPubMedGoogle Scholar
  • 77 Dzeshka MS, Shantsila A, Shantsila E. et al. Atrial fibrillation and hypertension. Hypertension 2017; 70: 854-861
    CrossrefPubMedGoogle Scholar
  • 78 Reincke M, Fischer E, Gerum S. et al. Observational study mortality in treated primary aldosteronism: the German Conn's registry. Hypertension 2012; 60: 618-624
    CrossrefPubMedGoogle Scholar
  • 79 Liao CW, Lin LY, Hung CS. et al. Time course and factors predicting arterial stiffness reversal in patients with aldosterone-producing adenoma after adrenalectomy: prospective study of 102 patients. Sci Rep 2016; 6: 20862
    CrossrefPubMedGoogle Scholar
  • 80 Rossi GP, Maiolino G, Flego A. et al. Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term. Hypertension 2018; 71: 585-591
    CrossrefPubMedGoogle Scholar
  • 81 Hundemer GL, Curhan GC, Yozamp N. et al. Incidence of atrial fibrillation and mineralocorticoid receptor activity in patients with medically and surgically treated primary aldosteronism. JAMA Cardiol 2018; 3: 768-774
    CrossrefPubMedGoogle Scholar
  • 82 Pan CT, Liao CW, Tsai CH. et al. Influence of different treatment strategies on new-onset atrial fibrillation among patients with primary aldosteronism: a nationwide longitudinal cohort-based study. J Am Heart Assoc 2020; 9: e013699
    PubMedGoogle Scholar
  • 83 Hundemer GL, Curhan GC, Yozamp N. et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018; 6: 51-59
    CrossrefPubMedGoogle Scholar
  • 84 Rossi GP, Cesari M, Cuspidi C. et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013; 62: 62-69
    CrossrefPubMedGoogle Scholar
  • 85 Rossi GP, Sacchetto A, Pavan E. et al. Remodeling of the left ventricle in primary aldosteronism due to Conn's adenoma. Circulation 1997; 95: 1471-1478
    CrossrefPubMedGoogle Scholar
  • 86 Indra T, Holaj R, Štrauch B. et al. Long-term effects of adrenalectomy or spironolactone on blood pressure control and regression of left ventricle hypertrophy in patients with primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2015; 16: 1109-1117
    CrossrefPubMedGoogle Scholar
  • 87 Lin YH, Huang KH, Lee JK. et al. Factors influencing left ventricular mass regression in patients with primary aldosteronism post adrenalectomy. J Renin Angiotensin Aldosterone Syst 2011; 12: 48-53
    CrossrefPubMedGoogle Scholar
  • 88 Lin YH, Lee HH, Liu KL. et al. Reversal of myocardial fibrosis in patients with unilateral hyperaldosteronism receiving adrenalectomy. Surgery 2011; 150: 526-533
    CrossrefPubMedGoogle Scholar
  • 89 Chang YY, Liao CW, Tsai CH. et al. Left ventricular dysfunction in patients with primary aldosteronism: a propensity score-matching follow-up study with tissue doppler imaging. J Am Heart Assoc 2019; 8: e013263
    PubMedGoogle Scholar
  • 90 Choi M, Scholl UI, Yue P. et al. K+ channel mutations in adrenal aldosterone-producing adenomas and hereditary hypertension. Science 2011; 331: 768-772
    CrossrefPubMedGoogle Scholar
  • 91 Gomez-Sanchez CE, Oki K. Minireview: potassium channels and aldosterone dysregulation: is primary aldosteronism a potassium channelopathy?. Endocrinology 2014; 155: 47-55
    CrossrefPubMedGoogle Scholar
  • 92 Williams TA, Monticone S, Mulatero P. KCNJ5 mutations are the most frequent genetic alteration in primary aldosteronism. Hypertension 2015; 65: 507-509
    CrossrefPubMedGoogle Scholar
  • 93 Rossi GP, Cesari M, Letizia C. et al. KCNJ5 gene somatic mutations affect cardiac remodelling but do not preclude cure of high blood pressure and regression of left ventricular hypertrophy in primary aldosteronism. J Hypertens 2014; 32: 1514-1521
    CrossrefPubMedGoogle Scholar
  • 94 Lenzini L, Rossitto G, Maiolino G. et al. A meta-analysis of somatic KCNJ5 K(+) channel mutations in 1636 patients with an aldosterone-producing adenoma. J Clin Endocrinol Metab 2015; 100: E1089-E1095
    CrossrefPubMedGoogle Scholar
  • 95 Wu VC, Huang KH, Peng KY. et al. Prevalence and clinical correlates of somatic mutation in aldosterone producing adenoma-Taiwanese population. Sci Rep 2015; 5: 11396
    CrossrefPubMedGoogle Scholar
  • 96 Fujimoto K, Honjo S, Tatsuoka H. et al. Primary aldosteronism associated with subclinical Cushing syndrome. J Endocrinol Invest 2013; 36: 564-567
    PubMedGoogle Scholar
  • 97 Spath M, Korovkin S, Antke C. et al. Aldosterone- and cortisol-co-secreting adrenal tumors: the lost subtype of primary aldosteronism. Eur J Endocrinol 2011; 164: 447-455
    CrossrefPubMedGoogle Scholar
  • 98 Tang L, Li X, Wang B. et al. Clinical characteristics of aldosterone- and cortisol-coproducing adrenal adenoma in primary aldosteronism. 2018 4920841.
    PubMedGoogle Scholar
  • 99 Kamenicky P, Redheuil A, Roux C. et al. Cardiac structure and function in Cushing's syndrome: a cardiac magnetic resonance imaging study. J Clin Endocrinol Metab 2014; 99: E2144-E2153
    CrossrefPubMedGoogle Scholar
  • 100 van der Hooft CS, Heeringa J, Brusselle GG. et al. Corticosteroids and the risk of atrial fibrillation. Arch Intern Med 2006; 166: 1016-1020
    CrossrefPubMedGoogle Scholar
  • 101 Liu SY, Chu CC, Tsui TK. et al. Aldosterone-producing adenoma in primary aldosteronism: CT-guided radiofrequency ablation-long-term results and recurrence rate. Radiology 2016; 281: 625-634
    CrossrefPubMedGoogle Scholar
  • 102 Amar L, Azizi M, Menard J. et al. Aldosterone synthase inhibition with LCI699: a proof-of-concept study in patients with primary aldosteronism. Hypertension 2010; 56: 831-838
    CrossrefPubMedGoogle Scholar
  • 103 Morimoto R, Omata K, Ito S. et al. Progress in the management of primary aldosteronism. Am J Hypertens 2018; 31: 522-531
    CrossrefPubMedGoogle Scholar