Specific electrocardiographic features associated with Cushing's disease
Krystallenia I Alexandraki1, Gregory A Kaltsas, Apostolos-Ilias Vouliotis
1Department of Endocrinology, St Bartholomew's Hospital, London, UK.
Insights
Cardiovascular disease (CVD) risk in Cushing's disease (CD) is linked to specific ECG changes. Prolonged QTcd, independent of hypertension, is a key indicator in CD patients.
Area of Science:
- Endocrinology
- Cardiology
- Medical Diagnostics
Background:
- Hypercortisolaemia, a condition of excess cortisol, significantly elevates cardiovascular disease (CVD) risk.
- This risk may stem from direct myocardial effects or exacerbation of traditional CVD risk factors.
Purpose of the Study:
- To determine if electrocardiogram (ECG) alterations in Cushing's disease (CD) can be predicted solely by analyzing associated risk factors.
- Investigate specific ECG parameters in CD patients.
Main Methods:
- Retrospective analysis of 79 CD patients, assessing ECG parameters (QTc, QTcd, ECG-LVH, ECG-RVH), blood pressure, and biochemical/hormonal data.
- Comparison with 42 healthy controls matched for demographics.
Main Results:
- CD patients exhibited higher prevalence of metabolic syndrome, hypertension, CVD, hypercholesterolemia, hypertriglyceridemia, and carbohydrate abnormalities.
- Patients with CD showed significantly longer QTcd, more prevalent left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH) compared to controls.
- Prolonged QTcd was independently predicted by CD and ECG-evidenced LVH, irrespective of other risk factors like hypertension.
Conclusions:
- Prolonged QTcd, particularly when associated with ECG evidence of LVH, is a distinctive feature of Cushing's disease.
- These findings may inform therapeutic strategies for CD and its associated comorbidities.
Objective:
Hypercortisolaemia is associated with an increased risk of cardiovascular disease (CVD), either through a direct action on the myocardium or by increased traditional cardiovascular risk factors. The aim of this study was to investigate whether the alterations in the ECG in Cushing's disease (CD) are predictable from risk factor analysis alone.
Design:
In 79 patients with a diagnosis of CD, retrospectively recruited, ECG features [corrected for heart rate QT (QTc), QTc dispersion (QTcd), left ventricular hypertrophy (ECG-LVH), right ventricular hypertrophy (ECG-RVH)], systolic (SBP) and diastolic (DBP) blood pressure were assessed. Biochemical, hormonal (cortisol at 09·00 h or cortisol day curve, CDC) and carbohydrate abnormalities (CHA), history of hypertension and cardiovascular disease were recorded. For comparison reasons, a group of 42 healthy subjects matched for gender, age and body mass index previously subjected to ECG assessment were selected.
Results:
In patients with CD, we noted the following prevalence: metabolic syndrome 39%, hypertension 81%, CVD 21·5%, hypercholesterolaemia 37%, hypertriglyceridaemia 29%, CHA 41%, but a history of cardiac dysrhythmia was only noted in a single patient. No difference in QTc or QTcd was shown between patients with normal or low potassium levels. QTcd >50 ms was associated with both increased ECG-LVH and ECG-RVH. When compared to the control group, patients had longer QTcd (P < 0·001), more prevalent LVH (P < 0·001) and RVH (P = 0·001), and higher SBP and DBP (P < 0·001), but similar QTc. Both CD and ECG evidence of LVH predicted prolonged QTcd, but the association of CD with a prolonged QTcd was independent of other risk factors, including hypertension.
Conclusions:
Prolonged QTcd in association with ECG evidence of LVH appears to be the specific feature of CD. This may be relevant in the choice of medical therapy for CD and for consideration of treatment of the comorbidities that are associated with hypercortisolaemia.
Related Concept Videos
01:26Cushing Syndrome I: Introduction
01:19Cushing Syndrome II: Pathophysiology
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Dysrhythmias III: Characteristics of Dysrhythmias
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations