https://scholars.lib.ntu.edu.tw/handle/123456789/424775
標題: | Clinical Outcomes of 1625 Patients With Primary Aldosteronism Subtyped With Adrenal Vein Sampling | 作者: | Rossi, Gian Paolo Rossitto, Giacomo Amar, Laurence Azizi, Michel Riester, Anna Reincke, Martin Degenhart, Christoph Widimsky, Jiri Naruse, Mitsuhide Deinum, Jaap Schultze Kool, Leo Schultze Kool L. Negro, Aurelio Rossi, Ermanno Kline, Gregory Tanabe, Akiyo Satoh, Fumitoshi Christian Rump, Lars Christian Rump L. Willenberg, Holger S Fuller, Peter J Fuller P.J. Chee, Nicholas Yong Nian Magill, Steven B Shafigullina, Zulfiya Quinkler, Marcus Oliveras, Anna KWAN-DUN WU VIN-CENT WU Barbiero, Giulio Battistel, Michele CHIN-CHEN CHANG Vanderriele, Paul-Emmanuel Pessina, Achille C Pessina A.C. |
關鍵字: | adrenal vein sampling; adrenalectomy; diagnosis; hypertension; patient selection; potassium; subtyping | 公開日期: | 十月-2019 | 卷: | 74 | 期: | 4 | 來源出版物: | Hypertension (Dallas, Tex. : 1979) | 摘要: | 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. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/424775 | ISSN: | 0194-911X 1524-4563 |
DOI: | https://api.elsevier.com/content/abstract/scopus_id/85072134175 10.1161/HYPERTENSIONAHA.119.13463 |
顯示於: | 醫學系 |
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