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Epicardial and Pericardial Adiposity Without Myocardial Steatosis in Cushing Syndrome

Peter Wolf1,2, Benjamin Marty3, Khaoula Bouazizi4,5

  • 1Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France.

The Journal of Clinical Endocrinology and Metabolism
|August 1, 2021
PubMed

Insights

Patients with Cushing syndrome have increased epicardial and pericardial fat, but not intramyocardial fat. Disease remission reduced epicardial fat, highlighting the impact of cortisol excess on cardiac fat accumulation.

Area of Science:

  • Cardiology
  • Endocrinology
  • Medical Imaging

Background:

  • Cardiovascular disease is a leading cause of mortality in Cushing syndrome patients.
  • Cortisol excess and metabolic dysfunction contribute to cardiac fat accumulation, potentially impairing heart function.

Purpose of the Study:

  • To investigate cardiac fat mass and distribution in individuals with Cushing syndrome.
  • To compare fat distribution in Cushing syndrome patients with healthy controls.
  • To assess the impact of disease remission on cardiac fat.

Main Methods:

  • Prospective, cross-sectional study involving 23 Cushing syndrome patients and 27 controls.
  • Cardiac magnetic resonance imaging and proton spectroscopy were used to measure myocardial, epicardial, and pericardial fat.
  • Measurements were taken before and after achieving biochemical disease remission.

Main Results:

  • Epicardial fat mass was significantly increased in Cushing syndrome patients compared to controls (30.8 g/m2 vs 17.2 g/m2).
  • Pericardial fat mass was also significantly elevated in patients (28.3 g/m2 vs 11.4 g/m2).
  • Intramyocardial lipid content did not differ between groups; disease remission reduced epicardial fat but not pericardial fat.

Conclusions:

  • Cushing syndrome is associated with substantial epicardial and pericardial fat accumulation, independent of intramyocardial fat.
  • Epicardial adiposity may promote cardiomyopathy through paracrine proinflammatory effects.
  • Cortisol excess influences cardiac fat distribution, with potential benefits of disease remission on epicardial fat reduction.
Abstract

Keywords:
Cushing syndromecardiac magnetic resonance imagingcardiac steatosiscardiomyopathypericardial and epicardial fatproton magnetic resonance spectroscopy

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