Non-invasive left ventricular pressure-strain loop study on cardiac fibrosis in primary aldosteronism: a comparative study with cardiac magnetic resonance imaging

We investigated the potential diagnostic value of the myocardial work indices based on speckle tracking echocardiography for cardiac fibrosis in patients with primary aldosteronism. Our observational study included 48 patients with primary aldosteronism. We performed conventional echocardiography and the left ventricular pressure-strain loop analysis. We also performed cardiac magnetic resonance imaging to evaluate cardiac replacement fibrosis defined as late gadolinium enhancement (LGE). Patients with LGE (n = 30, 62.5%) had longer duration of hypertension and higher plasma NT-proBNP than those without LGE. Besides, they had a significantly (P <= 0.04) higher left ventricular mass index (121.3 +/- 19.5 vs. 103.3 +/- 20.0 g/m(2)) and global wasted work (205 +/- 78 vs. 141 +/- 36 mmHg%) and lower global longitudinal strain (-17.7 +/- 1.8 vs. -19.0 +/- 2.4%) and work efficiency (GWE, 90.9 +/- 2.4 vs. 93.8 +/- 1.5%). Receiver Operating Characteristics analysis showed that GWE <= 92% had a sensitivity and specificity of 76.7% and 83.3%, respectively, for LGE with the area under curve 0.85 (P < 0.001). In conclusion, both cardiac structure and function were impaired in patients with primary aldosteronism and cardiac fibrosis. The myocardial work index GWE showed significant value for the indication of cardiac fibrosis.