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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Vascular and cardiac function in young adults with classical congenital adrenal hyperplasia
Joanna Wierzbicka-Chmiel1, Artur Chmiel, Sławomir Rychlik
1Department of Endocrinology, Hospital Rybnik, Poland. jwierzbickachmiel@wp.pl.
Insights
Young adults with congenital adrenal hyperplasia (CAH) on long-term glucocorticoid therapy show impaired vascular function and subclinical cardiac changes. This study highlights potential cardiovascular risks in CAH patients despite treatment.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Biology
Background:
- Patients with classical congenital adrenal hyperplasia (CAH) face elevated cardiovascular risks.
- The long-term effects of corticoid replacement therapy on vascular and cardiac function in CAH are not fully understood.
Purpose of the Study:
- To evaluate vascular and cardiac function in adult patients with CAH undergoing long-term glucocorticoid replacement therapy.
- To compare vascular parameters and cardiac function between CAH patients and healthy controls.
Main Methods:
- A cross-sectional study involving 19 Caucasian adults with CAH and 20 matched healthy volunteers.
- Assessment included flow-mediated dilation (FMD) of the brachial artery, intima-media thickness (cIMT, fIMT) of carotid and femoral arteries, standard echocardiography, and 2D speckle-tracking echocardiography (LSTE) for global longitudinal strain.
Main Results:
- CAH patients exhibited significantly decreased FMD compared to controls (9.4% vs. 19.8%).
- Intima-media thickness (cIMT and fIMT) was initially higher in CAH patients but not after confounder correction.
- Left ventricular ejection fraction and mass index were similar; however, LSTE revealed subclinical differences in global longitudinal strain (-20.5% vs. -22.5%).
Conclusions:
- Long-lasting glucocorticoid treatment in young adults with CAH is associated with impaired FMD.
- While IMT showed an insignificant increase, subclinical changes in left ventricular diastolic function were detected via echocardiography.
Introduction:
Patients with classical congenital adrenal hyperplasia (CAH) have increased cardiovascular risk, but the vascular and cardiac function during longitudinal corticoids replacement therapy is not known thoroughly.
Material And Methods:
Cross-sectional study of 19 Caucasian adults with CAH (age 23.7 ± 3.8 years; twelve males) compared to 20 healthy volunteers matched for origin, sex, age, and body mass index (BMI). All of the participants were assessed for flow mediated dilatation of the brachial artery (FMD), intima-media thickness of the common carotid artery (cIMT) and common femoral artery (fIMT), standard echocardiography, and global longitudinal left ventricular function using two-dimensional speckle-tracking echocardiography (LSTE).
Results:
The patients with CAH, compared with controls, had decreased FMD (9.4 ± 3.9 vs. 19.8 ± 5.2; p < 0.01), and the difference was still significant after correction for potential confounders. cIMT and fIMT were higher in the CAH group at baseline (for cIMT 0.47 ± 0.4 mm vs. 0.40 ± 0.03 mm; p < 0.01, for fIMT 0.47 ± 0.05 mm vs. 0.41 ± 0.04 mm; p < 0.01) but not after correction for potential confounders. The CAH subjects, compared with controls, had normal or similar left ventricular (LV) ejection fraction and LV mass index. The mean absolute value of LSTE differed in the CAH patients compared with controls (-20.5% ± 1.2 vs. -22.5% ± 1.7; p < 0.01), but it was still within the normal range.
Conclusions:
Young adults with CAH and glucocorticoid long-lasting treatment had impaired FMD, an insignificant increase of IMT, and subclinical changes in LV diastolic function in echocardiography.
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