Decreased Plasma Clearance and Hepatic Extraction of Aldosterone in Patients with Heart Failure*

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Abstract
The secretion rate and clearance of aldosterone from plasma were measured in 17 patients during cardiac catheterization. In 9 cases, the hepatic extraction ratio of aldosterone was determined. Three patients had asymptomatic septal defects and 14 had valvular heart disease with functional impairment varying from minimal to advanced congestive heart failure. All had received prior medical treatment. Studies were made in the recumbent position. Aldosterone secretion rate was increased in 5 cases with heart failure, who had received a low sodium intake and previous diuretic therapy. The clearance of labeled aldosterone from plasma was decreased in patients with moderate or advanced congestive failure. This decrease was better correlated with increased systemic arterio-venous oxygen difference than with reduced cardiac output, and was attributed at least in part to reduced hepatic blood flow. The hepatic extraction ratio of aldosterone was below normal in cases with advanced congestive heart failure. Impaired hepatic extraction was attributed to hepatic cellular dysfunction, chiefly due to anoxia as demonstrated by markedly reduced hepatic venous saturation. Impaired hepatic extraction was also associated with elevated right atrial pressure in 3 of 4 instances. Reduced clearance of aldosterone implies a proportional increase in the estimated plasma aldosterone concentration for any given rate of secretion. The highest estimates of plasma aldosterone concentration were seen in those patients with moderate to severe failure, in whom both increased secretion and reduced clearance occurred. Increased plasma aldosterone was associated with decreased sodium excretion in the urine.