Yuan CZ, Ze F, Li D
… +5 more, Wu CC, He JS, Wei H, Zhou JL, Li XB
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139650
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To evaluate the clinical feasibility of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation following transvenous lead extraction (TLE). This was a retrospective study. Consecutive patients who unde...To evaluate the clinical feasibility of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation following transvenous lead extraction (TLE). This was a retrospective study. Consecutive patients who underwent S-ICD implantation at Peking University People's Hospital between June 2015 and October 2023 were enrolled. Patients were divided into the TLE group and the newly implanted group based on whether they received TLE prior to S-ICD implantation. Baseline characteristics, S-ICD indication, defibrillation threshold test results, complications, and postoperative follow-up data were collected and compared between the two groups. A total of 27 patients were included, aged (49.2±14.2) years, including 19 males. There were 12 patients in the TLE group and 15 in the newly implanted group. Compared with the TLE group, patients in the newly implanted group were younger ((43.3±13.7) years vs. (55.6±12.0) years, =0.013). The main S-ICD indication in the TLE group was high infection risk (9/12), whereas in the newly implanted group it was younger age (11/15). All patients underwent successful S-ICD implantation, with 18 patients completing defibrillation threshold testing (all successful). Additionally, the TLE group had longer follow-up duration than the newly implanted group (42 (19, 60) months vs. 12 (3, 28) months, =0.001). No complications or deaths occurred during follow-up, with normal device function in both groups. A total of 17 ventricular tachycardia or fibrillation events were recorded, of which 7 met defibrillation criteria and all received effective therapy. S-ICD demonstrates safety and efficacy as a therapeutic option for patients after TLE, with comparable device functionality and follow-up outcomes to patients with newly implanted S-ICD.
Tang YR, Chen X, Wang B
… +6 more, Su ML, Chen X, Gao QM, Huang XY, Yao YE, Wang Y
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139649
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To quantitatively analyze right ventricular reverse remodeling in patients with severe tricuspid regurgitation after transcatheter tricuspid edge-to-edge repair (T-TEER) by two-dimensional speckle tracking echocardiograp...To quantitatively analyze right ventricular reverse remodeling in patients with severe tricuspid regurgitation after transcatheter tricuspid edge-to-edge repair (T-TEER) by two-dimensional speckle tracking echocardiography, and to preliminarily evaluate the clinical efficacy of this procedure. This study was a prospective single-center cohort study. Patients diagnosed with severe tricuspid regurgitation at the Xiamen Cardiovascular Hospital Xiamen University from March 2021 to June 2023 were enrolled. All patients underwent transthoracic echocardiography and transesophageal three-dimensional echocardiography before T-TEER, and transthoracic echocardiography at 30 days, 6 months, and 9 months after T-TEER. The primary endpoint was major adverse cardiovascular and cerebrovascular events, including death, stroke, myocardial infarction, reoperation, arrhythmia, and conduction block. Other clinical evaluation indicators included New York Heart Association (NYHA) functional classification and tricuspid regurgitation grade. A total of 34 patients were enrolled, aged (67.9±9.3) years, and 71% (24/34) were female. The median follow-up duration was 9 months. All patients achieved a reduction of tricuspid regurgitation by ≥2 grades at 9 months after T-TEER, with 79% (27/34) of them having mild to moderate tricuspid regurgitation. Transthoracic echocardiography at 9 months after T-TEER showed that the vena contracta width of tricuspid regurgitation ((5.42±2.33) mm vs. (11.54±4.05) mm, <0.001), effective regurgitant orifice area ((0.24±0.09) cm² vs. (0.52±0.14) cm², <0.001), regurgitant jet area ((7.95±4.02) cm² vs. (13.93±6.10) cm², <0.001), inferior vena cava diameter ((19.38±2.63) mm vs. (23.56±3.31) mm, <0.001), right ventricular end-diastolic diameter ((28.03±6.26) mm vs. (33.21±8.24) mm, =0.001), and tricuspid annular diameter ((36.47±4.40) mm vs. (41.44±7.08) mm, <0.001) were all reduced compared with baseline; while the tricuspid annular plane systolic excursion ((18.08±5.25) mm vs. (14.91±3.42) mm, =0.005) and right ventricular fractional area change ((37.61±7.52)% vs. (30.79±9.06)%, =0.004) were both increased compared with baseline. At 9 months after T-TEER, all patients had a NYHA functional classification of grade Ⅰ or Ⅱ, and no major adverse cardiovascular and cerebrovascular event occurred during the follow-up period. It is preliminarily confirmed that T-TEER is safe and effective in the treatment of severe tricuspid regurgitation, with significant right ventricular reverse remodeling observed in patients at 9 months after T-TEER.
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139648
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To analyze the impact of achieving behavioral and metabolic factor control targets on cardiovascular disease (CVD) risk in hypertensive patients. This retrospective study utilized data from the National Enssential Publi...To analyze the impact of achieving behavioral and metabolic factor control targets on cardiovascular disease (CVD) risk in hypertensive patients. This retrospective study utilized data from the National Enssential Public Health Service program in Kunshan City, Jiangsu Province. Hypertensive patients who participated in the program in 2018 were enrolled and divided into six groups accoding to the number (0-1, 2, 3, 4, 5, or 6) of controlled behavioral and metabolic factors (blood glucose, blood pressure, low-density lipoprotein cholesterol, obesity, smoking, and physical activity). Baseline data were collected from the 2018 health examinations and stratified intervention management records to analyze the distribution of characteristics across groups. Patients were followed up, with incident CVD during follow-up as the primary outcome. Competing-risk Cox proportional hazards regression model was employed to assess the impact of achieving behavioral and metabolic control targets on CVD risk. Differences in cumulative incidence of CVD between groups were compared using Gray's test for equality of cumulative incidence functions. The population attributable fractions (PAF) for each behavioral and metabolic factors were calculated using the "averisk" package in R software. A total of 87 338 hypertensive patients were included, aged (62.88±9.14) years, with 42 419 males (48.57%). During a follow-up of 75.0 (60.0, 77.0) months, 10 200 incident cases of CVD and 3 187 non-CVD deaths were recorded. The cumulative incidence of CVD was 13.69% (95% 13.35-14.03), with no statistically significant difference between males and females (13.99% vs. 13.41%, =0.246). Cox regression analysis revealed that after adjusting for confounders, the risk of CVD in hypertensive patients showed a decreasing trend with an increasing number of controlled behavioral and metabolic factors ( for trend<0.001). Specifically, achieving all six control targets was associated with a 48% reduction in CVD risk (=0.52, 95% 0.44-0.62, <0.001) compared to achieving only 0-1 control targets. Moreover, the combined PAF of all six factors for CVD incidence was 23.98% (95% 19.99%-27.97%). Physical inactivity had the highest PAF (8.70% (95% 5.19%-12.21%)), followed by uncontrolled blood glucose (7.30% (95% 6.36%-8.25%)) and elevated low-density lipoprotein cholesterol (5.54% (95% 3.58%-7.50%)). Compared to achieving only 0-1 control targets, attaining all six behavioral and metabolic control targets was associated with a 48% reduction in CVD risk among hypertensive patients. Furthermore, controlling all six factors could prevent 23.98% of CVD cases in the hypertensive population. Therefore, multifactorial coordinated interventions should be prioritized as a core strategy in the National Essential Public Health Services Program to effectively achieve the goal of primary CVD prevention at the population level.
Wang L, Zhang H, Li C
… +7 more, Yin XM, Li ZQ, He Q, Sun XQ, Xia DC, Kong DL, Lu CZ
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139647
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To investigate the ultra-long-term antihypertensive efficacy, safety, major adverse events, and survival benefits of renal denervation (RDN) in patients with resistant hypertension (rHTN) and mild chronic kidney disease...To investigate the ultra-long-term antihypertensive efficacy, safety, major adverse events, and survival benefits of renal denervation (RDN) in patients with resistant hypertension (rHTN) and mild chronic kidney disease (CKD). This real-world, single-center retrospective study enrolled patients with rHTN and mild CKD who underwent RDN at Tianjin First Central Hospital between October 2011 and June 2016. Office blood pressure, home self-measured blood pressure, 24-hour ambulatory blood pressure, serum creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio were collected at baseline and at 1, 5, and 13 years post-RDN. The total daily defined dose of antihypertensive medications at 13 years post-RDN was recorded, along with endpoint events during follow-up, including cardiovascular death, all-cause death, hospitalization for heart failure, myocardial infarction, and stroke. Patients were stratified according to CKD stage (G1-G2 vs. G3a) and baseline systolic blood pressure (mild-to-moderate vs. severe hypertension), and follow-up data were compared across subgroups. A total of 40 patients were included, aged (51±15) years, including 26 (65%) males. At the 13-year follow-up, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by (-32±20) mmHg and (-15±14) mmHg (1 mmHg=0.133 kPa), respectively; reductions in home self-measured blood pressure (SBP: (-25±14) mmHg, DBP: (-10±11) mmHg) and 24-hour ambulatory blood pressure (SBP: (-16±9 mmHg, DBP: (-10±6) mmHg) were also observed, alongside a reduction in the total daily defined dose of antihypertensive medications by (1.1±0.9) compared to baseline. Renal function assessments showed no significant differences at 13 years versus baseline in serum creatinine ((105±51) μmol/L vs. (96±22) μmol/L), estimated glomerular filtration rate ((72±22) ml·min·1.73 m vs. (78±17) ml·min·1.73 m), or urine albumin-to-creatinine ratio ((101±86) mg/g vs. (127±82) mg/g) (all >0.05). All-cause and cardiovascular mortality rates during follow-up were 13% (5/40) and 8% (3/40), respectively. Subgroup analysis results showed that, although CKD G1-G2 patients had smaller reductions in office SBP ((-31±20) mmHg vs. (-34±19) mmHg) and DBP ((-13±10) mmHg vs. (-25±18) mmHg) compared to G3a patients at 13 years, intergroup differences were not significant (all >0.05). In contrast, severe hypertension subgroup exhibited greater reductions in office SBP ((-55±13) mmHg vs. (-20±10) mmHg) and DBP ((-24±17) mmHg vs. (-13±10) mmHg) versus mild-to-moderate hypertension subgroup (all <0.05). RDN demonstrates sustained antihypertensive efficacy with favorable renal safety in rHTN patients with mild CKD. Patients with higher baseline systolic blood pressure may exhibit better responsiveness to RDN.
Qu CL, Yang N, Wei MT
… +4 more, Yin SQ, Chen SH, Wu SL, Li YM
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139646
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To explore the relationship between long-term blood pressure variability and arteriosclerosis in women with a history of hypertensive disorders in pregnancy (HDP). This study was a retrospective cohort study. Data were...To explore the relationship between long-term blood pressure variability and arteriosclerosis in women with a history of hypertensive disorders in pregnancy (HDP). This study was a retrospective cohort study. Data were obtained from the Kailuan Research Database. Women with a history of HDP who delivered between January 1990 and December 2020 and completed brachial-ankle pulse wave velocity (baPWV) measurement in the postpartum period were enrolled. Baseline data were obtained from the first post-delivery health examination, while the outcome measure was the baPWV recorded during the last follow-up visit, synchronized with blood pressure measurements. Based on long-term blood pressure variability, the enrolled study subjects were divided into the first, second, and third tertile groups in ascending order using the tertile method, and intergroup differences in clinical characteristics were compared. Multivariable logistic regression was performed to evaluate the impact of long-term blood pressure variability levels on arteriosclerosis risk in women with a history of HDP. Sensitivity analyses excluded individuals with multiple deliveries to validate the robustness of findings. Subgroup analyses were conducted based on delivery age (<40 vs. ≥40 years) and blood pressure measurement frequency (3 vs. >3 times) to explore the potential impact of different population characteristics on the study results. A total of 421 study subjects were enrolled, aged (36.07±6.05) years, with a baPWV value of (1 376.80±238.18) cm/s. Long-term blood pressure variability was 4.66 (3.41, 6.50) mmHg (1 mmHg=0.133 kPa). The first, second and third quartile group included 140, 141 and 140 individuals, respectively. In the total population, the incidence of arteriosclerosis was 40.4% (170/421). The incidence rates in the first, second, and third tertile groups were 34.3% (48/140), 39.0% (55/141), and 47.9% (67/140), respectively. Multivariate logistic regression analysis showed that increased long-term blood pressure variability was an independent risk factor for arteriosclerosis in women with a history of HDP (=1.702, 95% 1.018-2.844, =0.043). The results of sensitivity analyses were consistent with that of the primary analysis (=1.758, 95% 1.044-2.959, =0.034). Subgroup analyses further indicated that in the subgroups with delivery age <40 years (=2.116, 95% 1.153-3.885, =0.016) and blood pressure measurement frequency >3 times (=1.894, 95% 1.069-3.355, =0.029), the association between long-term blood pressure variability and arterial stiffness risk was more significant. For women with a history of HDP, elevated long-term blood pressure variability may increase the risk of arteriosclerosis, and this effect is more pronounced in younger women (delivery age <40 years) and those with high-frequency blood pressure measurements (>3 times). Enhanced monitoring and management of blood pressure variability in this population are crucial to improving long-term cardiovascular health outcomes.
Chinese Society of Cardiology, Chinese Medical Association, Professional Committee of Cardiopulmonary Prevention and Rehabilitation of Chinese Rehabilitation Medical Association, Editorial Board of Chinese Journal of Cardiology
Zhonghua Xin Xue Guan Bing Za Zhi
· 2025 Oct · PMID 41139645
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To investigate the association of Chinese visceral adiposity index (CVAI) with arterial stiffness progression. This study was a prospective cohort study, which included participants who completed at least 1 measurement...To investigate the association of Chinese visceral adiposity index (CVAI) with arterial stiffness progression. This study was a prospective cohort study, which included participants who completed at least 1 measurement of brachial-ankle pulse wave velocity (baPWV) between 2010 and 2016, with complete physical examination data during the same period, and completed baPWV measurement during follow-up. The time of completing the first baPWV measurement was defined as the baseline. All participants were divided into 4 groups according to quartiles of baseline CVAI (<60.84, 60.84-89.67, 89.68-117.45,≥117.46). The baPWV progression was calculated (baPWV progression=(baPWV-baPWV)/duration of follow-up). We assessed the association of CVAI groups with baPWV progression using multivariate linear regression models. A total of 17 261 participants were included. Of these, the age was (47.6±11.6) years, and 11 285 (65.38%) were males. The results of multivariate linear regression models showed that compared with the CVAI<60.84 group, the baPWV at baseline increased by 39.62 cm/s (95% 28.57-50.67, <0.01) in the 60.84-89.67 group, 76.37 cm/s (95% 64.71-88.04, <0.01) in the 89.68-117.45 group, and 92.83 cm/s (95% 80.53-105.14, <0.01) in the≥117.46 group. The median follow-up time was 2.49 years. Compared with the CVAI<60.84 group, annual change of baPWV progression increased by 17.17 cm/s (95% 10.36-23.97, <0.01) in the 60.84-89.67 group, 24.59 cm/s (95% 17.38-31.80, <0.01) in the 89.68-117.45 group, and 25.75 cm/s (95% 18.13-33.36, <0.01) in the ≥117.46 group. Higher CVAI is closely associated with the progression of arterial stiffness, and the arterial stiffness progression accelerates with increased CVAI.
To evaluate the diagnostic value of coronary angiography-derived fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) for identifying coronary functional abnormalities. This diagnostic study enro...To evaluate the diagnostic value of coronary angiography-derived fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) for identifying coronary functional abnormalities. This diagnostic study enrolled patients with clinically suspected or diagnosed coronary artery disease who underwent coronary angiography at Beijing Anzhen Hospital, TEDA International Cardiovascular Hospital, and Qilu Hospital of Shandong University between December 2021 and June 2022. All enrolled patients successfully underwent invasive wire-based FFR and IMR measurements during angiography. In a core laboratory, FFR and IMR for the target vessels were measured using artificial intelligence technology based on coronary angiographic images. Spearman correlation analysis was used to evaluate the correlation between angiography-derived FFR and wire-based FFR, and between angiography-derived IMR and wire-based IMR. Coronary hemodynamic abnormality was defined as FFR≤0.80; the diagnostic performance of angiography-derived FFR for identifying this abnormality was evaluated. Microcirculatory dysfunction was defined as IMR≥25; the diagnostic performance of angiography-derived IMR for identifying microcirculatory dysfunction was evaluated. A total of 181 patients, aged (60.6±8.8) years, with 62 (34.3%) females, and 181 target vessels were included in the final analysis. Angiography-derived FFR showed a significant positive correlation with wire-based FFR (=0.78, <0.001). For identifying coronary hemodynamic abnormality, angiography-derived FFR showed an accuracy of 89.0%, sensitivity of 88.8%, specificity of 89.1%, positive predictive value (PPV) of 88.8%, negative predictive value (NPV) of 89.1%, and an area under the receiver operating characteristic curve () of 0.88. Angiography-derived IMR showed a significant positive correlation with wire-based IMR (=0.93, <0.001). For identifying microcirculatory dysfunction, angiography-derived IMR demonstrated an accuracy of 89.5%, sensitivity of 86.8%, specificity of 90.2%, PPV of 70.2%, NPV of 96.3%, and an of 0.95. Angiography-derived FFR and IMR exhibit strong correlations with their invasive wire-based counterparts and demonstrate high diagnostic value for assessing coronary hemodynamics and coronary microcirculatory function.
To explore the value of metanephrine, normetanephrine, and some steroid hormones in the assessment of adrenal venous sampling (AVS). This retrospective study enrolled 101 patients with primary aldosteronism who underwen...To explore the value of metanephrine, normetanephrine, and some steroid hormones in the assessment of adrenal venous sampling (AVS). This retrospective study enrolled 101 patients with primary aldosteronism who underwent AVS at Peking Union Medical College Hospital between June 1, 2021, and October 1, 2024. Multiple hormones, including aldosterone, cortisol, metanephrine, normetanephrine and steroid hormone profiles, were measured in samples from the inferior vena cava and bilateral adrenal veins during AVS. Selectivity index and lateralization index were calculated based on the levels of different hormones to determine successful AVS cannulation (selectivity index≥2) and aldosterone hypersecretion lateralization (lateralization index≥2). Patients who underwent unilateral adrenalectomy were followed for at least 6 months. Clinical and biochemical outcomes were assessed according to the Primary Aldosteronism Surgical Outcome (PASO) criteria, with biochemical remission defined as achieving complete or partial biochemical remission postoperatively. The efficacy of different hormones relative to cortisol for calculating selectivity index and lateralization index was evaluated for subtype classification. The age at diagnosis of the enrolled patients was (50.5±9.6) years, including 77 males. Regarding the selectivity index, five hormones including metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone, and dehydroepiandrosterone demonstrated significantly higher selectivity index compared to cortisol (all <0.05). Based on the cortisol-derived selectivity index, AVS cannulation was unsuccessful in 8 patients; using the five indices, unsuccessful cannulation occurred in 2, 2, 3, 4, and 5 patients, respectively. Based on postoperative follow-up, 55 patients were identified as having unilateral surgically relievable primary aldosteronism. In identifying these patients, the performance of metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone, and dehydroepiandrosterone was non-inferior to cortisol, correctly identifying 95% (52/55), 93% (51/55), 91% (50/55), 87% (48/55), and 89% (49/55) of cases, respectively. However, among these patients, there were no statistically significant differences in the success rate of intubation in AVS and the ability to identify patients with unilateral primary aldosteronism between the five indicators and cortisol (all >0.05). Using cortisol-based lateralization as the reference standard, androstenedione and dehydroepiandrosterone both achieved an accuracy of 90% (84/93) for determining the lateralized side, while 17α-hydroxypregnenolone, normetanephrine, and metanephrine achieved accuracies of 89% (83/93), 81% (74/93), and 80% (73/93), respectively. Metanephrine, normetanephrine, androstenedione, 17α-hydroxypregnenolone and dehydroepiandrosterone could increase the success rate of intubation in AVS, with a high ability to identify patients with unilateral primary aldosteronism, and are expected to replace cortisol as new indicators of AVS.
To explore the optimal cut-off value of aldosterone-to-renin ratio (ARR) for primary aldosteronism screening in hypertensive populations stratified by sex and age. This study was a cross-sectional study. Patients who we...To explore the optimal cut-off value of aldosterone-to-renin ratio (ARR) for primary aldosteronism screening in hypertensive populations stratified by sex and age. This study was a cross-sectional study. Patients who were diagnosed with hypertension from November 2016 to December 2023 at the First Affiliated Hospital of Dalian Medical University were included. Upright direct renin concentration (DRC) and plasma aldosterone concentration (PAC) were measured using chemiluminescence, and the ARR was calculated as PAC/DRC. Patients were divided into primary aldosteronism and primary hypertension groups based on the results of comprehensive screening tests and confirmatory tests (saline infusion test and/or captopril challenge test). Spearman correlation analysis was used to explore the correlation between ARR and age. Patients were stratified by age (≤40, >40 to 50, >50 to 60, and >60 years) and sex. The efficacy of ARR for primary aldosteronism screening was assessed by drawing the receiver operating characteristic curve and calculating the area under curve (), and to explore the optimal cut-off values for different ages and sexes. A total of 1 282 hypertensive patients were enrolled, aged 46.0 (37.0, 56.0) years with 746 males. ARR showed a positive correlation with age in both primary aldosteronism (=0.168, =0.007) and primary hypertension patients (=0.327, <0.001). In the general population, male patients, and female patients, the values of ARR screening for primary aldosteronism were 0.975 (95% 0.967-0.982), 0.989 (95% 0.983-0.995), 0.957 (95% 0.942-0.972), respectively. In the four groups of patients ≤40, >40 to 50, >50 to 60, and >60 years, the values of ARR screening for primary aldosteronism were 0.990 (95% 0.983-0.997), 0.973 (95% 0.958-0.988), 0.965 (95% 0.947-0.982), 0.958 (95% 0.933-0.984), respectively. In the four groups of patients aged ≤40, >40 to 50, >50 to 60, and >60 years, the optimal ARR cut-off values for primary aldosteronism screening were 2.31, 2.67, 2.94, and 3.68 (ng·dl)/(mU·L)(1 ng/dl=27.7 pmol/L), respectively. The optimal ARR cut-off values for primary aldosteronism screening were 2.37 and 2.94 (ng·dl)/(mU·L) in male and female patients, respectively. The optimal cut-off value of ARR in the screening of primary aldosteronism increases with age, and the optimal cut-off value of ARR in female patients is higher than that in male patients. The ARR cut-off value should be selected individually based on the patient's characteristics in clinical practice.
To investigate the correlations of KCNJ5 gene mutations and pathological subtypes based on 11β-hydroxylase (CYP11B1)/aldosterone synthase (CYP11B2) immunohistochemistry with clinical characteristics and postoperative out...To investigate the correlations of KCNJ5 gene mutations and pathological subtypes based on 11β-hydroxylase (CYP11B1)/aldosterone synthase (CYP11B2) immunohistochemistry with clinical characteristics and postoperative outcomes in patients with unilateral primary aldosteronism undergoing adrenalectomy. This retrospective study enrolled 155 patients with primary aldosteronism who underwent unilateral adrenalectomy at the Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, between May 2023 and May 2024. KCNJ5 mutations were detected by Sanger sequencing, and patients were stratified into KCNJ5-mutant and wild-type groups based on genetic results. The KCNJ5-mutant cohort was further subclassified into complete remission and partial remission groups according to surgical outcomes. For KCNJ5-mutant cases, postoperative tissues underwent immunohistochemical subtyping for CYP11B1/CYP11B2 expression, and were divided into the CYP11B2 mono-positive group (CYP11B1/CYP11B2) and the CYP11B1/CYP11B2 co-expression group (CYP11B1/CYP11B2). Correlations of KCNJ5 mutations and pathological subtypes with baseline characteristics, biochemical profiles, and postoperative outcomes in unilateral primary aldosteronism patients were analyzed. A total of 100 patients were included in the final analysis, aged (51.1±11.0) years, including 35 females (35%). The somatic KCNJ5 mutation rate was 69% (69/100), with 69 KCNJ5-mutant and 31 wild-type cases. Compared to wild-type patients, KCNJ5-mutant patients were younger ((48.4±10.8) years vs. (56.9±9.3) years, =0.000 2), had a higher female proportion (45% vs. 13%, =0.004 0), exhibited lower preoperative renin levels (3.4 (1.1, 39.5) ng/L vs. 9.7 (2.7, 19.6) ng/L, =0.009 1) and had a higher rate of complete clinical remission (55% vs. 16%, =0.000 3). Among KCNJ5-mutant patients, 38 achieved complete remission and 31 achieved partial remission. The complete remission group demonstrated younger age ((45.6±10.2) years vs. (52.0±10.5) years, =0.012 6), shorter hypertension duration ((6.2±6.1) years vs. (10.7±10.1) years, =0.020 4), higher preoperative plasma (951.5 (652.2, 1 690.8) pmol/L vs. 749.8 (518.5, 955.4) pmol/L, =0.027 7) and urinary ((86 271.4±51 873.8) pmol/24 h vs. (61 860.2±24 411.2) pmol/24 h, =0.019 2) aldosterone levels, greater lateralization index (22.6 (10.1, 42.5) vs. 11.1 (5.1, 19.8), =0.022 7), fewer baseline antihypertensive defined daily dose (2.6±1.3 vs. 4.0±1.3, <0.000 1), and larger tumor diameter (1.5 (1.2, 1.8) cm vs. 1.1 (1.0, 1.5) cm, =0.000 7). Immunohistochemical subtyping revealed CYP11B2 mono-positivity in 24 mutant cases and CYP11B1/CYP11B2 co-expression in 45. The CYP11B2 mono-positive group showed more pronounced postoperative reduction in antihypertensive defined daily dose (2.9±1.3 vs. 2.2±1.2, =0.018 3), though no significant difference in complete remission rates (46% vs. 60%, =0.259 8) was observed. In patients with unilateral primary aldosteronism, those carrying KCNJ5 somatic mutations exhibit characteristics such as younger age and a higher proportion of females compared to wild-type patients, along with significantly better surgical outcomes. Moreover, among patients with KCNJ5 mutations, those whose pathological subtype shows pure CYP11B2 expression demonstrate a more pronounced reduction in postoperative antihypertensive defined daily dose than those with co-expression of CYP11B1/CYP11B2.
To investigate the long-term efficacy and influencing factors of transcatheter adrenal ablation in patients with primary aldosteronism (PA). This cohort study retrospectively enrolled PA patients who underwent transcath...To investigate the long-term efficacy and influencing factors of transcatheter adrenal ablation in patients with primary aldosteronism (PA). This cohort study retrospectively enrolled PA patients who underwent transcatheter adrenal ablation at Daping Hospital, Army Medical University between January 2021 and December 2024. According to PASO criteria, patients were categorized into groups based on clinical outcomes (complete, partial, or no remission), biochemical outcomes (complete, partial, or no remission), and composite outcomes (complete or incomplete remission). All participants underwent 1-year follow-up, with intergroup comparisons of clinical characteristics and surgical approaches. Multivariate logistic regression models were used to identify factors influencing long-term efficacy post-transcatheter adrenal ablation in PA patients. A total of 122 PA patients were enrolled, aged (47.7±11.1) years, including 55 males (45.1%). Baseline aldosterone-to-renin ratio was 0.43(0.19,0.86)(pmol·L)/(μU·L). Bilateral adrenal lesions were present in 33 cases (27.1%), while 70 (57.4%) had nodules or adenomas. Adrenal venous sampling confirmed lateralized hypersecretion in 107 patients (87.7%, left or right dominance). According to PASO criteria, 93.4% (114/122) and 95.1% (116/122) of patients achieved complete or partial remission in biochemical and clinical parameters at 1-year post-ablation, respectively. For biochemical outcomes: 40 complete, 74 partial, and 8 no remission. Patients in the partial-remission group were older than those in the no-remission group ((49.4±11.2) vs. (39.6±9.8) years), while complete-remission group had higher bilateral non-lateralized secretion rates than partial remission group (27.5% vs. 4.1%, both <0.05). For clinical outcomes: 26 complete, 90 partial, 6 no remission. Compared to complete-remission group, partial-remission group had higher male proportion (51.1% vs. 26.9%), longer hypertension duration (4.0 (0.7, 10.0) years vs. 1.5 (0.1, 5.0) years), but lower office diastolic blood pressure ((88±11) mmHg vs. (94±12 mmHg), 1 mmHg=0.133 kPa, all <0.05). For composite outcomes: 56 complete and 66 incomplete remission. Compared with incomplete remission group, complete remission group had lower prevalence of diabetes (8.9% vs. 22.7%) and higher proportion of bilateral non-lateralized secretion (21.4% vs. 4.6%, both <0.05). Multivariate logistic regression identified diabetes (=3.635, 95% 1.029-12.834, =0.045) and lateralized secretion (=9.056, 95% 2.039-40.212, =0.004) as independent risk factors for poor composite outcomes after transcatheter adrenal ablation in PA patients, whereas higher office diastolic blood pressure acts as a protective factor (=0.957, 95% 0.925-0.992, =0.015). One year after transcatheter adrenal ablation, the majority of patients achieved complete or partial remission in biochemical and clinical parameters.Patients with non-lateralized adrenal hypersecretion demonstrated a higher likelihood of sustained biochemical remission and superior composite outcomes compared to those with lateralized hypersecretion.