Abstract
Novel echocardiographic techniques, such as speckle tracking echocardiography (STE) and tissue Doppler imaging, are sensitive tools for assessing left ventricular (LV) performance. LV global longitudinal strain (GLS), assessed by STE, is a sensitive marker of myocardial systolic function. Cardiovascular complications in patients with Cushing's disease (CD) determine a higher mortality than that in an age- and gender-matched population. Cardiac systolic dysfunction may be detected in early stages by STE. Thus, the aim of this study was to investigate the usefulness of STE in detecting subclinical LV dysfunction in three groups of patients: CD group, arterial hypertension group (AHG), and healthy volunteers (HV). Echocardiographic assessments of LV systolic and diastolic function were performed in 171 subjects (CD: 22, AHG: 114, HV: 35) with no symptoms of heart failure. A statistical comparison included separate analyses for men and women. CD patients showed good blood pressure (BP) control (below 140/90 mmHg in 82% of cases). However, in comparison AHG and HV groups they exhibited: (1) significantly lower LV contractility expressed by GLS (CD group: -17.7%, AHG group: -19.2%, HV: -20.0%; p = 0.004) and (2) higher prevalence of LV diastolic dysfunction (45.0, 14.2, 0.0%, respectively; p < 0.00001). Men with CD showed significantly more pronounced LV diastolic dysfunction. Cortisol excess in women was related to impaired LV systolic function. CD, even with well-controlled BP, is associated with LV dysfunction which depends individually on sex. These hemodynamic alterations can be detected by modern non-invasive diagnostic tools and may become potential therapeutic objectives.
Highlights
Cushing’s disease (CD) is a severe endocrine disease resulting in a chronic excess of glucocorticoids [1]
The CD group consisted of patients with Cushing’s disease diagnosed based on standard hormonal criteria: increased urinary free cortisol (UFC), increased serum cortisol levels at 8.00 a.m., loss of cortisol circadian rhythm, increased or detectable plasma adrenocorticotropic hormone (ACTH) levels at 8.00 a.m., and failure to suppress serum cortisol levels to
In comparison with the arterial hypertension group (AHG) and Healthy volunteers (HV) groups, the CD group exhibited: [1] significantly lower left ventricular (LV) contractility expressed by global longitudinal strain (GLS) (CD group −17.7%, AHG group −19.2%, HV −20.0%; p = 0.004) despite comparable Left ventricular ejection fraction (LVEF) (66.9, 66.4, 67.5%, respectively; ns) (Figure 1; Table 1)
Summary
Cushing’s disease (CD) is a severe endocrine disease resulting in a chronic excess of glucocorticoids [1]. Arterial hypertension (AH) is the most common cardiovascular disease in patients with CD. AH is very common for all types of hypercortisolism (both endogenous and exogenous). It seems that hypertensive patients with CD should be treated like other hypertensive patients. Patients with CD have a higher risk of other cardiovascular diseases. Patients with an active form of CD have higher rates of heart failure and acute myocardial infarction than healthy people [4]. CD patients have been reported to exhibit higher rates of structural left ventricular (LV) alterations in the form of LV hypertrophy and concentric remodeling as well as functional LV alterations, such as decreased LV systolic performance and impaired diastolic filling [5]
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