Assessing Lateralization Index of Adrenal Venous Sampling for Surgical Indication in Primary Aldosteronism. | Read by QxMD (original) (raw)

Hiroki Kobayashi, Yoshihiro Nakamura, Masanori Abe, Oskar Ragnarsson, Eleftheria Gkaniatsa, Marianne Aa Grytaas, Kristian Løvås, Norio Wada, Takamasa Ichijo, Daniel A Heinrich, William Drake, Sam O'Toole, Tomaz Kocjan, Darko Kastelan, Ivana Kraljevic, Koichi Yamamoto, Mika Tsuiki, Simon Kloock, Ulrich Dischinger, Mirko Parasiliti-Caprino, Gruber Sven, Ariadni Spyroglou, Raluca Maria Furnica, Francesco Fallo, Giuseppe Maiolino, Mitsuhiro Kometani, Vin-Cent Wu, Felix Beuschlein, Martin Reincke, Mitsuhide Naruse

BACKGROUND: Clinical practice guidelines recommend the Lateralization Index (LI) as the standard for determining surgical eligibility in primary aldosteronism (PA). Our goal was to identify the optimal LI cut-offs in adrenal venous sampling (AVS) for diagnosing PA that is amenable to surgical cure.

METHODS: We conducted a retrospective international cohort study across 16 institutions in 11 countries, including 1,550 patients with PA who underwent AVS, with and/or without ACTH stimulation. The establishment of optimal cut-offs was informed by a survey of 82 PA patients in Japan, aimed at determining the LI cut-off aligned with patient expectations for a surgical cure rate.

RESULTS: The survey revealed that a median cure rate expectation of 80% would motivate PA patients towards undergoing adrenalectomy. The optimal LI cut-offs achieving an adjusted positive predictive value (PPV) of 80% were identified as 3.8 for unstimulated AVS and 3.4 for ACTH-stimulated AVS. Furthermore, a contralateral ratio of less than 0.4 and the detection of an adrenal nodule on CT imaging were identified as independent predictors of surgically curable PA. Incorporating these factors with the optimal LI cut-offs, the adjusted PPV increased to 96.6% for unstimulated AVS and 89.6% for ACTH-stimulated AVS. No clear differences in predictive ability between unstimulated and ACTH-stimulated LI were found.

CONCLUSIONS AND RELEVANCE: The present study clarified the optimal LI cut-offs for without and with ACTH stimulation. The presence of contralateral suppression and adrenal nodule on CT imaging seems to provide additional available information besides LI for surgical indication.