Abstract: Background　Primary aldosteronism (PA), one of the most common causes of secondary hypertension, is closely associated with ventricular remodeling. However, the characteristics of ventricular remodeling in patients with PA remain incompletely understood, and specific diagnostic biomarkers are currently lacking. Objective　To investigate the characteristics and associated factors of ventricular remodeling in patients with PA and to evaluate the diagnostic value of serum soluble suppression of tumorigenicity 2 (sST2) and cardiotrophin-1 (CT-1) levels for ventricular remodeling in patients with PA. Methods　A total of 105 patients with confirmed PA who were hospitalized at the Hypertension Center of Kunming Yan'an Hospital from May 2023 to May 2025 were enrolled. During the same period, 105 hospitalized patients with essential hypertension (EH), matched with PA patients for gender, age, and admission blood pressure levels were included. Clinical characteristics and laboratory parameters were compared between patients with PA and those with EH. Left ventricular hypertrophy (LVH) in patients with PA was assessed according to the left ventricular mass index (LVMI). Based on the presence or absence of LVH, patients with PA were divided into the ventricular remodeling group and the non-ventricular remodeling group. Clinical characteristics, serum sST2 levels, and CT-1 levels were compared between the two groups. Spearman rank correlation analysis was performed to identify factors associated with LVMI in patients with PA. Multivariate Logistic regression analysis was conducted with ventricular remodeling as the dependent variable. Receiver operating characteristic (ROC) curves were generated, and the area under the ROC curve (AUC) was calculated to evaluate the diagnostic performance of sST2 and CT-1 for ventricular remodeling in patients with PA. Results　Compared with patients with EH, patients PA had a longer duration of hypertension, higher rates of previous antihypertensive medication use and of using antihypertensive drugs with potential effects on improving ventricular remodeling. They also had higher serum sodium levels, higher upright plasma aldosterone concentration (PAC), higher upright aldosterone-to-renin activity ratio (ARR), and higher daytime systolic blood pressure (SBP), daytime diastolic blood pressure (DBP), nighttime SBP, nighttime DBP, 24-hour SBP, and 24-hour DBP. In contrast, the prevalence of hyperlipidemia, upright plasma renin activity (PRA), and serum potassium levels were lower in patients with PA than in those with EH (P<0.05). Patients with PA had larger left atrial diameter (LA), right atrial diameter (RA), right ventricular diameter (RV), interventricular septal thickness (IVST), left ventricular posterior wall thickness at end-diastole (LVPWT), left ventricular mass (LVM), and LVMI compared with patients with EH. The proportion of patients with LVH was also higher in patients with PA than in those with EH (P<0.05). According to the presence or absence of LVH, patients with PA were divided into the ventricular remodeling group (n=26) and the non-ventricular remodeling group (n=79). Compared with the non-ventricular remodeling group, patients in the ventricular remodeling group had higher body weight, upright PAC, daytime SBP, daytime DBP, nighttime SBP, 24-hour SBP, 24-hour DBP, serum sST2 levels, and CT-1 levels (P<0.05). Spearman rank correlation analysis showed that body weight, daytime SBP, daytime DBP, nighttime SBP, 24-hour SBP, upright PAC, sST2, and CT-1 were positively correlated with LVMI in patients with PA （rs=0.452, 0.359, 0.196, 0.417, 0.391, 0.450, 0.389, 0.476, P<0.05）. Multivariate Logistic regression analysis showed that daytime SBP, upright PAC, sST2 (OR=1.057, 95%CI=1.024-1.192), and CT-1 (OR=1.023, 95%CI=1.004-1.042) were independently associated with ventricular remodeling in patients with PA. ROC curve analysis showed that upright PRA (AUC=0.776) and daytime SBP(AUC=0.738) had limited diagnostic value, whereas CT-1(AUC=0.856) and sST2(AUC=0.888) demonstrated high sensitivity(96.2%, 96.2%) but relatively low specificity (72.2%, 77.2%) for diagnosing ventricular remodeling. A diagnostic model incorporating upright PRA, sST2, and CT-1 (AUC=0.906), based on the multivariate Logistic regression model improved diagnostic specificity(86.1%) while maintaining relatively high sensitivity (84.6%). The combined model incorporating upright PRA, sST2, CT-1, and daytime SBP showed higher diagnostic performance (AUC=0.913) and sensitivity (92.3%), but relatively lower specificity (77.2%). Conclusion　Compared with patients with EH, patients with PA exhibited more pronounced ventricular remodeling. Upright PAC, sST2, CT-1, and daytime SBP were significantly positively correlated with LVMI in patients with PA. Serum sST2 and CT-1 were independent risk factors for left ventricular remodeling in patients with PA and demonstrated potential diagnostic value for ventricular remodeling in this Population.

Key words: Primary aldosteronism, Ventricular remodeling, Left ventricular mass index, CT-1, sST2

摘要： 背景　原发性醛固酮增多症（PA）作为常见的继发性高血压之一，与心室重构密切相关，但目前PA患者心室重构的特点尚未完全明确，也缺乏特异性的诊断生物标志物。目的　探讨PA患者心室重构的特点、影响因素及血清可溶性生长刺激表达基因2蛋白（sST2）和心肌营养素1（CT-1）水平对PA患者心室重构的诊断价值。方法　纳入2023年5月—2025年5月在昆明市延安医院高血压中心住院确诊的PA患者105例，同期纳入与PA患者性别、年龄、入院血压水平相匹配的原发性高血压（EH）住院患者105例。比较PA患者与EH患者的临床资料及实验室检查指标。依据左心室质量指数（LVMI）评估PA患者左心室肥厚（LVH）情况，按照是否存在LVH将PA患者分为心室重构组与非心室重构组，比较2组患者的临床资料、血清sST2及CT-1的差异。采用Spearman秩相关分析确定与PA患者LVMI有相关的因素，并以心室重构作为因变量进行多因素Logistic回归分析，绘制受试者工作特征（ROC）曲线，并计算ROC曲线下面积（AUC），探究sST2、CT-1对PA患者心室重构的诊断效能。结果　PA患者高血压病程长于EH患者，既往服用降压药物及服用具有改善心室重构作用的降压药物的比例、血钠、立位PAC、立位醛固酮与肾素活性比值（ARR）、日间收缩压、日间舒张压、夜间收缩压、夜间舒张压、全天收缩压和全天舒张压均高于EH患者，合并高脂血症比例、立位血浆肾素活性（PRA）和血钾均低于EH患者（P<0.05）。PA患者左心房内径（LA）、右心房内径（RA）、右心室内径（RV）、室间隔厚度（IVST）、左心室后壁舒张末期厚度（LVPWT）、左心室质量（LVM）及LVMI均高于EH患者，LVH所占比例亦高于EH患者（P<0.05）。依据是否存在LVH，PA患者中心室重构组26例、非心室重构组79例。心室重构组患者体质量、立位PAC、日间收缩压、日间舒张压、夜间收缩压、全天收缩压、全天舒张压、sST2、CT-1水平均高于非心室重构组（P<0.05）。Spearman秩相关分析结果显示，PA患者的体质量、日间收缩压、日间舒张压、夜间收缩压、全天收缩压、立位PAC、sST2、CT-1与LVMI呈正相关（rs=0.452、0.359、0.196、0.417、0.391、0.450、0.389、0.476，P<0.05）。多因素Logistic回归分析结果显示，日间收缩压、立位PAC、sST2（OR=1.057，95%CI=1.024~1.192）、CT-1（OR=1.023，95%CI=1.004~1.042）是PA患者心室重构的危险因素。ROC曲线分析结果显示，立位PRA（AUC=0.776）及日间收缩压（AUC=0.738）诊断价值有限，而CT-1（AUC=0.856）、sST2（AUC=0.888）在诊断心室重构方面具备高灵敏度（96.2%、96.2%）、低特异度（72.2%、77.2%）的特征；通过多因素Logistic回归模型构建的立位PRA、sST2、CT-1诊断模型（AUC=0.906）在提升诊断的特异度（86.1%）的同时仍保持可保持较高的灵敏度水平（84.6%）；而纳入立位PRA、sST2、CT-1及日间收缩压的联合模型诊断价值（AUC=0.913）及灵敏度（92.3%）较高，但特异度偏低（77.2%）。结论　PA患者相较EH患者心室重构程度更为严重。PA患者的立位PAC、sST2、CT-1、日间收缩压与LVMI呈显著正相关，sST2、CT-1是PA患者左心室重构的危险因素，对PA患者的心室重构具有一定的诊断效能。

关键词: 原发性醛固酮增多症, 心室重构, 左室质量指数, 心肌营养素 1, 可溶性生长刺激表达基因 2 蛋白