The Predictive Effect Of Contralateral Suppression Index On Superselective Adrenal Artery Embolization For Primary Aldosteronism

Objective:To explore the predictive effect of contralateral inhibition index(CSI)after superselective adrenal artery embolization(SAAE)in patients with primary aldosteronism(PA).Methods:We continuously included patients who were diagnosed with PA in the second affiliated Hospital of Nanchang University from January 2018 to January 2021.The postoperative family blood pressure,antihypertensive drugs,plasma aldosterone and potassium,creatinine and e GFR levels were evaluated.The contralateral inhibition index was calculated according to the AVS results,and the differences of postoperative indexes between CSI < 1 group and CSI ≥ 1 group were compared,and the final clinical results were evaluated.Results:(1)The systolic blood pressure(SBP),diastolic blood pressure(DBP)and whole-day systolic blood pressure(SBP)and diastolic blood pressure(DBP)were significantly decreased at 1,3,6 and 12 months after SAAE(P < 0.001).The dosage of antihypertensive drugs at 1 and 3 months after operation was lower than that before operation(P < 0.05),but there was no significant difference at 6 and 12 months after operation(P > 0.05).(2)The level of serum potassium increased at 1,3,6 and 12 months after SAAE(P < 0.001,respectively),and the aldosterone level in orthostatic position decreased1,3 and 12 months after operation(P < 0.01,P < 0.01,0.002 and 0.039,respectively).There was no significant difference in orthostatic aldosterone at 6 months after operation(P > 0.05).The level of renin in orthostatic position increased significantly at 1,3,6 and 12 months after operation(P < 0.001,P < 0.008,respectively).The level of cortisol at 1,3 and 6 months after operation was higher than that before operation(Preservation 0.002 and 0.014 respectively).There was no significant difference in cortisol at 12 months after operation(P > 0.05).There was no significant difference in creatinine and e GFR between 1,3,6 and 12 months after operation(P > 0.05).(3)One month after SAAE,the family systolic blood pressure and whole-day systolic blood pressure in the CSI < 1 group were lower than those in the CSI ≥ 1group(P < 0.01,respectively).There was no significant difference in family,whole-day diastolic blood pressure,antihypertensive drug dosage,orthostatic aldosterone,orthostatic renin,serum potassium and cortisol 1 month after operation.Six months after operation,the family systolic blood pressure in CSI < 1 group was lower than that in CSI ≥ 1 group(P < 0.015).There was no significant difference in family diastolic blood pressure,whole-day systolic blood pressure,whole-day diastolic blood pressure,antihypertensive drug dosage,orthostatic aldosterone,orthostatic renin,serum potassium and cortisol between CSI < 1 group and CSI ≥ 1group at 6 months after operation.There was no significant difference in blood pressure and biochemical indexes between CSI < 1 group and CSI ≥ 1 group at 3 and12 months after operation.(4)The difference of family systolic blood pressure in CSI < 1 group was larger than that in CSI ≥ 1 group at 1,3 and 6 months after SAAE(P < 0.001).One month after operation,the difference of whole-day systolic blood pressure in CSI < 1 group was greater than that in CSI ≥ 1 group(P < 0.015).One month after operation,the difference of aldosterone decrease in CSI < 1 group was greater than that in CSI ≥ 1group(P < 0.017).(5)Univariate logistic regression analysis showed that age(OR = 0.941,1995),smoking history(OR = 0.952,95%,0.913,0.994,P = 0.024),preoperative family systolic blood pressure(OR = 1.043,95%,1.011,1.07,P = 0.008),preoperative family diastolic blood pressure(OR,1.067,95%,1.022,1.115,P = 0.003),smoking history(0.952,95%,0.913,0.994,P = 0.024),preoperative family diastolic blood pressure(OR = 1.067,95,95%,1.022,1.115,P = 0.003).There was a significant correlation between the prognosis of blood pressure after SAAE and CSI(OR =0.681,95%,0.494,0.938,respectively,P = 0.019).Further multivariate logistic regression found that CSI(OR = 0.682,95% CI,0.467,0.995,P = 0.047),preoperative family systolic blood pressure(OR = 1.041,95% CI,1.002,1.002,P =0.041)was independently and significantly correlated with the prognosis of blood pressure after SAAE(6)ROC curve showed that there was a good correlation between CSI and the improvement of blood pressure after SAAE in patients with PA.Conclusion:(1)This study shows that CSI can predict the improvement of blood pressure after SAAE.(2)SAAE may be an effective intervention strategy to reduce blood pressure in patients with PA,and there are no obvious adverse events after operation.This method may be a potential treatment for patients with PA.