SIR 2024
Nonvascular Interventions
Marwan Moussa, MD
Instructor of Radiology
Beth Israel Deaconess Medical Center/ Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Omar Hamam, MD
Research Fellow
Beth Israel Deaconess Medical Center - Harvard Medical School
Disclosure information not submitted.
Godwin Abiola, MD
Resident
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Ammar Sarwar, MD, FSIR (he/him/his)
Associate Professor of Radiology
Harvard Medical School / Beth Israel Deaconess Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Salomao Faintuch, MD
Interventional Radiologist
Beth Israel Deaconess Medical Center - Harvard Medical School
Disclosure information not submitted.
Barry Sacks, MD
Faculty Interventional Radiologist
Beth Israel Deaconess Medical Center - Harvard Medical School
Disclosure information not submitted.
Muneeb Ahmed, MD, FSIR
Chief, Division of Interventional Radiology; Professor
Beth Israel Deaconess Medical Center/Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Radiofrequency ablation (RFA) is an emerging strategy for treatment of non-surgical candidates lateralized primary aldosteronism (PA). The Aldosteronoma Resolution Score (ARS) is surgically validated metric for prognostication of complete clinical cure after adrenalectomy. The purpose of this study is to validate ARS as a prognosticator for outcomes post RFA of primary aldosteronism patients.
Materials and Methods:
A retrospective study included 59 PA patients treated with RFA between 2007-2023. The clinical and biochemical data of the patients were collected, which included pre-operative and post-operative potassium levels, serum aldosterone levels, plasma renin activity levels, blood pressure measurements, and number and doses of antihypertensives and potassium supplements. Primary outcomes include descriptive analysis and AUC- ROC tests to assess the relation between ARS and outcomes post RFA. ARS were defined as “high likelihood of clinical cure” (4-5), “medium likehood of clinical cure” (2-3) and “low likelihood of clinical cure (0-1). Outcomes were defined as Complete clinical response (BP consistently below 140/90 mmHg, not requiring antihypertensives), Partial clinical response ( BP consistently below 140/90 mmHg, requiring antihypertensives however, less number and doses than before RFA) and Absent clinical response (BP consistently below 140/90 mmHg, requiring an unchanged number and dose antihypertensives than before RFA). ARS correlation with post RFA biochemical data was performed.
Results:
59 patients participated in this study among them were 17 females (29%) and 42 males (71%) with the mean age 54.4 years. The results of the study revealed that 15.3% of patients achieved total clinical success while 9% had high ARS Score (4-5), 45.8% had partial clinical success while 45% had medium ARS score (2-3). Finally, 39%, did not attain clinical success corresponding to 46% who had low ARS score (0-1). The analysis of the curve revealed a substantial confidence interval, suggesting that the accuracy of ARS in predicting biochemical results after surgery was limited. For potassium level the confidence interval was (95% CI: [0.399] to [0.748]), while for aldosterone levels the curve analysis indicated that the confidence interval was (95% CI: [0.280] to [0.849]) indicating that ARS is not a good predicator for the aldosterone level post-surgery (P= 0.647).
Conclusion:
The study provides preliminary evidence that ARS can be used as a predictive measure for clinical outcome in PA patients treated with RFA. Further larger studies are required to validate our findings.