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

Abstract

Purpose: Radiofrequency ablation (RFA) is an emerging treatment for treatment primary aldosteronism (PA). The Aldosteronoma Resolution Score (ARS) is a validated metric for prognostication of complete clinical response after adrenalectomy. The purpose of this study is to validate ARS as a prognosticator for outcomes post-RFA.

Material and methods: After IRB approval, patients treated with RFA for a unilateral aldosteronoma between 2007-2023 were retrospectively reviewed. Clinical and biochemical data were collected, including pre- and post-procedural potassium, aldosterone, plasma renin activity levels, blood pressure, number and doses of antihypertensives. Analysis included descriptive analysis and AUC- ROC tests assessing the relation between ARS and outcomes post-RFA. ARS 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 mmHg, without antihypertensives), partial clinical response (BP<140/90, requiring less antihypertensives pre-RFA) and absent clinical response (BP<140/90 mmHg, requiring unchanged antihypertensives pre-RFA). ARS correlation with post-RFA biochemical data was performed as an exploratory endpoint.

Results: In 59 patients (M 71%) with a mean age 54.4±10.3 years, 15% achieved complete clinical response while 8% had high ARS Score. 46% had partial response while 46% had medium ARS score. 39% had absent clinical response corresponding to 46% who had low ARS score. AUC = 0.891 (95% CI: 0.795-0.987) P<0.001, for predicting complete clinical response.

Conclusion: Preliminary evidence demonstrates that ARS can be used for predicting clinical outcomes in PA post-RFA.