The Aldosteronoma Resolution Score as a Predictive Metric for Outcomes after Radiofrequency Ablation for Primary Aldosteronism.

Abstract

Purpose: To validate the Aldosteronoma Resolution Score (ARS), a validated metric for prognostication of complete clinical response after adrenalectomy, as a prognosticator for outcomes after radiofrequency (RF) ablation for treatment of primary aldosteronism (PA).

Material and methods: After institutional review board (IRB) approval, patients treated with RF ablation for a unilateral aldosteronoma between 2007 and 2023 were retrospectively reviewed. Clinical and biochemical data were collected, including preprocedural and postprocedural potassium, aldosterone, and plasma renin activity levels; blood pressure (BP); and number and doses of antihypertensives. Analysis included descriptive analysis and area under the curve (AUC)-receiver operator characteristic tests assessing the relation between ARS and outcomes after RF ablation. ARSs were defined as "high likelihood of clinical response" (4-5), "medium likelihood of clinical response" (2-3), and "low likelihood of clinical response" (0-1). Outcome definitions were complete clinical response (BP < 140/90 mm Hg, without antihypertensives), partial clinical response (BP < 140/90 mm Hg, requiring less antihypertensives before RF ablation), and absent clinical response (BP < 140/90 mm Hg, requiring unchanged antihypertensives before RF ablation). ARS correlation with post-RF ablation biochemical data was performed as an exploratory endpoint.

Results: In 59 patients (71% men) with a mean age of 54.4 years (SD ± 10.3), 15% achieved complete clinical response and 8% had high ARS, 46% had partial response and 46% had medium ARS score, and 39% had absent clinical response and 46% had low ARS score. The AUC for predicting complete clinical response was 0.891 (95% CI, 0.795-0.987; P < .001).

Conclusions: Preliminary evidence demonstrated that ARS can be used for predicting clinical outcomes in PA after RF ablation.