ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Adrenal Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1567876
Myocardial fibrosis in primary aldosteronism
Provisionally accepted
- 1Shanghai Institute of Hypertension, Shanghai Jiao Tong University, Shanghai, China
- 2Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai Municipality, China
- 3School of Public Health, Shanghai Jiao Tong University, Shanghai, Shanghai Municipality, China
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Objective: We investigated myocardial fibrosis in relation to clinical and biochemical characteristics and the metabolomics in patients with primary aldosteronism. Methods: Our study included 54 patients with primary aldosteronism. We performed cardiac magnetic resonance to evaluate focal replacement myocardial fibrosis defined as late gadolinium enhancement (LGE) and diffuse interstitial fibrosis as assessed by extracellular volume (ECV) with T1 mapping. We collected information on demographics and data of clinical biomarkers, and performed echocardiography and metabolomic analysis. Results: Patients with LGE (n=30), compared with those without LGE (n=24), had a longer duration of hypertension, higher 24-hour, daytime and nighttime systolic blood pressure, left ventricular mass index, and plasma NT-proBNP (P<0.001). However, they had comparable T1 mapping measurements including ECV. LGE significantly (P<0.01) and positively correlated with the duration of hypertension, ambulatory systolic blood pressure and LVMI, while ECV and native T1 were significantly (P<0.05) and inversely associated with plasma renin activity and positively associated with aldosterone-to-renin ratio. Besides, both LGE and ECV significantly (P<0.05) and positively correlated with NT-proBNP. Non-targeted metabolomic analysis showed that the amino-acid metabolism, especially the L-glutamate metabolism, significantly differed between patients with LGE and those without LGE and correlated with blood pressure and echocardiographic measurements.Conclusion: In patients with primary aldosteronism, focal replacement fibrosis was associated with cardiac afterload factors such as blood pressure, while diffuse interstitial fibrosis was associated with hyperaldosteronism. The amino-acid metabolism, especially the L-glutamate metabolism, might be involved in the process of myocardial fibrosis.
Keywords: primary aldosteronism, Myocardial fibrosis, late gadolinium enhancement, Extracellular volume, Metabolomic analysis
Received: 28 Jan 2025; Accepted: 17 Apr 2025.
Copyright: © 2025 Chen, Chen, Ye, Xu, Zhu, Xu, Li and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ting-Yan Xu, Shanghai Institute of Hypertension, Shanghai Jiao Tong University, Shanghai, China
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