INFLUENCE OF COMORBIDITIES ON BLOOD ALDOSTERONE LEVEL IN CHRONIC HEART FAILURE WITH PRESERVED SYSTOLIC FUNCTION OF THE LEFT VENTRICLE

Aim. To analyze relation of blood aldosterone level with comorbidities in patients with chronic heart failure (CHF) with preserved ejection fraction of the left ventricle (EF LV).

Material and methods. To the cross-sectional study, 158 patients included: 58 males, 100 females, mean age 62,3±7,4 y. o., with decompensated CHF with preserved EF LV (>50%) and diastolic dysfunction. Patients did not present with primary hyperaldosteronism and did not take mineralocorticoid antagonists within previous 6 weeks. All patients underwent blood specimens collection, and were assessed on the comorbid disorders and conditions. Reference values of the hormone were 40-160 pg/mL.

Results. According to the measurements, all patients were selected to two groups: I group included 99 (67,1%) of patients, who had normal hormone level; II — 59 (37,3%) patients with hyperaldosteronemia. Group II patients were younger — 57,75±7,5 y. o. vs 65,02±7,1 y. o. (p<0,001) and had more prominent presentation of the CHF (NYHA III) — 62,7% vs 33,3% cases (p<0,001) comparing to the group I. The prevalence of previus myocardial infarction was — 59,3% vs 41,4% (p=0,044), comorbid atrial fibrillation — 33,9% vs 17,2% (p=0,027), long-term (>10 years) arterial hypertension (AH) — 57,6% vs 25,3% (p<0,001), chronic obstructive lung disease (COLD) — 27,1% vs 7,1% (p=0,001), diabetes mellitus — 39,0% and 19,2% (p=0,011), obesity — 64,4% and 29,3% (p<0,001), and renal dysfunction — 88,1% and 50,5% (p<0,001) in the group II significantly higher than in group I. Multiple regression showed that after correction by age and severity of CHF, only long lasting AH, COLD, obesity and renal dysfunction were associated with hyperaldosteronemia.

Conclusion. In CHF with preserved EF LV patients, aldosterone level is closely linked with comorbidities. Long term anamnesis of AH, presence of COLD, obesity and renal dysfunction are independent factors for the risk of secondary hyperaldosteronism.

1. Mareev VYu, Ageev FT, Arutyunov GP, et al. National guidelines for the diagnostic and management of heart failure of Society for heart failure, Russian Society of Cardiology and Russian Scientific Society of medical practitioners (fourth edition). Heart Failure 2013; 14 (7): 1-81. (in Russ.) Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П. и др. Национальные рекомендации ОССН, РКО и РНМОт по диагностике и лечению ХСН (четвертый пересмотр). Сердечная Недостаточность 2013; 14 (7): 1-81.

2. Mareev VYu, Fomin IV, Ageev FT, et al. Congestive heart failure. Heart Failure 2017; 18 (1): 3-40. (in Russ.) Мареев В. Ю., Фомин И. В., Агеев Ф. Т. и др. Хроническая сердечная недостаточность. Сердечная недостаточность 2017; 18 (1): 3-40.

3. Gilyarevskyi RS, Goldshmid MV, Kuzmina IM. The role of aldosterone antagonists in the prevention and treatment of cardiovascular and renal diseases: reality and prospects. Russian Medical Journal 2014; 22 (23): 1689-98. (in Russ.) Гиляревский С. Р., Голшмид М. В., Кузьмина И. М. Роль антагонистов альдостерона в профилактике и лечении сердечно-сосудистых и почечных заболеваний: реальность и перспективы. Русский медицинский журнал 2014; 22 (23): 1689-98.

4. He BJ, Anderson ME. Aldosterone and cardiovascular disease: the heart of the matter. Trends Endocrinol Metab. 2013; 24 (1): 21-30.

5. Gueder G, Hammer F, Deutschbein T. Prognostic value of aldosterone and cortisol in patients hospitalized for acutely decompensated chronic heart failure with and without mineralocorticoid receptor antagonism. J Card Fail 2015; 21 (3): 208-16.

6. Nagueh FS, Otto AS, 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.

7. Vatutin NT, Shevelok AN, Degtyareva AE, et al. The role of hyperaldosteronism and aldosterone antagonists in resistant arterial hypertension. J. of National academy of medical science of Ukraine 2014; 1 (20): 43-52. (in Russ.) Ватутин Н. Т., Шевелек А. Н., Дегтярева А. Э. и др. Роль гиперальдостеронизма и перспективы применения антагонистов альдостерона при резистентной артериальной гипертензии. Журнал национальной академии медицинских наук Украины 2014; 1 (20): 43-52.

8. Pankiv VI. Hyperaldosteronism: definition, etiology, classification, clinical signs and symptoms, diagnosis, treatment. International Journal of Endocrinology 2011; 39 (7): 122-9. (in Russ.) Панькив В. И. Гиперальдостерониз: определение, этиология, классификация, клинические признаки и синдромы, диагностика, лечение. Международный эндокринологический журнал 2011; 39 (7): 122-9).

9. Vasan RS, Evans JC, Larson MG, et al. Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N Engl J Med 2004; 351: 33-41. 10. Prakash ES. Aldosterone Escape or Refractory Hyperaldosteronism. Med Gen 2005; 7 (3): 25.

10. Kichigin VA, Gerasimova LI. Association of chronic obstructive pulmonary disease with blood levels of the adrenal cortex hormones. Modern problems of science and education 2016; 6: 27-32. (in Russ.) Кичигин В. А., Герасимова Л. И. Связь течения хронической обструктивной болезни легких с содержанием в крови гормонов коры надпочечников. Современные проблемы науки и образования 2016; 6: 27-32.

11. Markova TN, Parshin VV, Mishchenko NС. Secondary hyperaldosteronism is caused by abnormal development of the renal vessels, in clinical practice endocrinologist. Endocrine Surgery 2016; 10 (1): 28-34. (in Russ.) Маркова Т. Н., Паршин В. В., Мищенко Н. К. Вторичный гиперальдостеронизм, обусловленный аномалиями развития почечных сосудов, в клинической практике врача-эндокринолога. Эндокринная хирургия 2016; 10 (1): 28-34.

12. Karabaeva AZh. Aldosterone, cardiovascular system and kidneys. Nephrology 2006; 10 (1): 25-34. (in Russ.) Карабаева А. Ж. Альдостерон, сердечно-сосудистая система и почки. Нефрология 2006; 10 (1): 25-34.

13. Vatutin NT, Shevelok AN. Association of plasma aldosterone level with obesity in chronic heart failure with preserved ejection fraction. Clinical medicine 2016; 4: 265-9. (in Russ.) Ватутин Н. Т., Шевелёк А. Н. Взаимосвязь альдостерона крови и соматометрических параметров больных хронической сердечной недостаточностью с сохраненной фракцией выброса левого желудочка. Клиническая медицина 2016; 4: 265-9.

14. Smitka K, Marešová D. Adipose Tissue as an Endocrine Organ: An Update on Proinflammatory and Anti-inflammatory Microenvironment. Prague Med Re 2015; 116 (2): 87-11