Clinical Outcomes of 1625 Patients With Primary Aldosteronism Subtyped With Adrenal Vein Sampling
Gian Paolo Rossi
(1)
,
Giacomo Rossitto
(1, 2)
,
Laurence Amar
(3, 4)
,
Michel Azizi
(5, 3)
,
Anna Riester
(6)
,
Martin Reincke
,
Christoph Degenhart
(6)
,
Jiri Widimsky
(7)
,
Mitsuhide Naruse
(8)
,
Jaap Deinum
,
Leo Schultze Kool
(9)
,
Tomaz Kocjan
(10)
,
Aurelio Negro
(11)
,
Ermanno Rossi
(11)
,
Gregory Kline
(12)
,
Akiyo Tanabe
(13)
,
Fumitoshi Satoh
(14)
,
Lars Christian Rump
(15)
,
Oliver Vonend
(15)
,
Holger Willenberg
(16)
,
Peter Fuller
,
Jun Yang
,
Nicholas Yong Nian Chee
,
Steven Magill
(17)
,
Zulfiya Shafigullina
,
Marcus Quinkler
,
Anna Oliveras
(18)
,
Kwan Dun Wu
(19)
,
Vin-Cent Wu
(19)
,
Zusana Kratka
(20)
,
Giulio Barbiero
(1)
,
Michele Battistel
(1)
,
Chin-Chen Chang
(19)
,
Paul-Emmanuel Vanderriele
(1)
,
Achille Pessina
(1)
1
Unipd -
Università degli Studi di Padova = University of Padua
2 University of Glasgow
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
5 CIC 1418 - CIC - HEGP
6 Klinikum der Universität [München]
7 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
8 NHOKMC - National Hospital Organization Kyoto Medical Center [Kyoto, Japan]
9 Radboud University Medical Center [Nijmegen]
10 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
11 Arcispedale S Maria Nuova
12 University of Calgary
13 NCGM - National Center for Global Health and Medicine [Japan]
14 Tohoku University [Sendai]
15 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
16 University Medical Center Rostock
17 MCW - Medical College of Wisconsin [Milwaukee]
18 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
19 NTUH - National Taiwan University Hospital [Taipei]
20 North-Western State Medical University [St Petersburg, Russia]
2 University of Glasgow
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
5 CIC 1418 - CIC - HEGP
6 Klinikum der Universität [München]
7 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
8 NHOKMC - National Hospital Organization Kyoto Medical Center [Kyoto, Japan]
9 Radboud University Medical Center [Nijmegen]
10 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
11 Arcispedale S Maria Nuova
12 University of Calgary
13 NCGM - National Center for Global Health and Medicine [Japan]
14 Tohoku University [Sendai]
15 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
16 University Medical Center Rostock
17 MCW - Medical College of Wisconsin [Milwaukee]
18 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
19 NTUH - National Taiwan University Hospital [Taipei]
20 North-Western State Medical University [St Petersburg, Russia]
Gian Paolo Rossi
- Fonction : Auteur
- PersonId : 762906
- ORCID : 0000-0002-7963-0931
Giacomo Rossitto
- Fonction : Auteur
- PersonId : 777594
- ORCID : 0000-0001-9023-0835
Laurence Amar
- Fonction : Auteur
- PersonId : 759846
- ORCID : 0000-0003-3942-4276
- IdRef : 092993508
Michel Azizi
- Fonction : Auteur
- PersonId : 759639
- ORCID : 0000-0002-0815-0586
Anna Riester
- Fonction : Auteur
- PersonId : 818812
- ORCID : 0000-0003-3231-7435
Martin Reincke
- Fonction : Auteur
- PersonId : 758957
- ORCID : 0000-0002-9817-9875
Jiri Widimsky
- Fonction : Auteur
- PersonId : 794246
- ORCID : 0000-0001-8242-9705
Mitsuhide Naruse
- Fonction : Auteur
- PersonId : 807356
- ORCID : 0000-0002-8977-4090
Jaap Deinum
- Fonction : Auteur
- PersonId : 764906
- ORCID : 0000-0003-2465-1986
Tomaz Kocjan
- Fonction : Auteur
- PersonId : 808243
- ORCID : 0000-0001-8606-6825
Akiyo Tanabe
- Fonction : Auteur
- PersonId : 827111
- ORCID : 0000-0002-5682-4952
Peter Fuller
- Fonction : Auteur
Jun Yang
- Fonction : Auteur
- PersonId : 758845
- ORCID : 0000-0003-4620-4976
Nicholas Yong Nian Chee
- Fonction : Auteur
- PersonId : 827112
- ORCID : 0000-0002-9598-4908
Zulfiya Shafigullina
- Fonction : Auteur
Marcus Quinkler
- Fonction : Auteur
- PersonId : 776415
- ORCID : 0000-0003-4028-1671
Résumé
We sought to measure the clinical benefits of adrenal venous sampling (AVS), a test recommended by guidelines for primary aldosteronism (PA) patients seeking surgical cure, in a large registry of PA patients submitted to AVS. Data of 1625 consecutive patients submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America were collected in a large multicenter international registry. The primary end points were the rate of bilateral success, ascertained lateralization of PA, adrenalectomy, and of cured arterial hypertension among AVS-guided and non AVS-guided adrenalectomy patients. AVS was successful in 80.1% of all cases but allowed identification of unilateral PA in only 45.5% by the criteria in use at each center. Adrenalectomy was performed in 41.8% of all patients and cured arterial hypertension in 19.6% of the patients, 2-fold more frequently in women than men ( P <0.001). When AVS-guided, surgery provided a higher rate of cure of hypertension than when non-AVS-guided (40.0% versus 30.5%; P =0.027). Compared with surgical cases, patients treated medically needed more antihypertensive medications ( P <0.001) and exhibited a higher rate of persistent hypokalemia requiring potassium supplementation (4.9% versus 2.3%; P <0.01). The low rate of adrenalectomy and cure of hypertension in PA patients seeking surgical cure indicates suboptimal AVS use, possibly related to issues in patient selection, technical success, and AVS data interpretation. Given the better outcomes of AVS-guided adrenalectomy, these results call for actions to improve the diagnostic use of this test that is necessary for detection of surgical PA candidates. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01234220.