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The patient's sex determines the hemodynamic profile in patients with Cushing disease
Agnieszka Jurek1, Paweł Krzesiński1, Beata Uziębło-Życzkowska1
1Department of Cardiology and Internal Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland.
Insights
Males with Cushing disease (CD) exhibit higher afterload and worse hemodynamic function compared to females. These sex-based cardiovascular differences are crucial for personalized CD management.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- Cushing disease (CD) is linked to accelerated cardiovascular remodeling and increased mortality.
- Suspected sex-based differences exist in the mechanisms of cardiovascular dysfunction in CD patients.
Purpose of the Study:
- To assess the impact of patient sex on the hemodynamic profile in newly diagnosed Cushing disease patients.
- To evaluate cardiovascular function using impedance cardiography and echocardiography, considering sex differences.
Main Methods:
- A prospective study included 54 newly diagnosed CD patients (77.8% female, mean age 41).
- Impedance cardiography measured hemodynamic parameters (SVRI, TACI, HI, SI, CI, VI, ACI).
- Transthoracic echocardiography assessed cardiac chamber dimensions and left ventricular function.
Main Results:
- Males with CD showed higher afterload (increased SVRI, decreased TACI) compared to females.
- Males exhibited worse left ventricular hemodynamic function (lower HI, VI, SI, CI, ACI).
- No significant sex differences were found in echocardiographically assessed left ventricular systolic or diastolic function.
Conclusions:
- Male patients with Cushing disease present with a less favorable hemodynamic profile, characterized by higher afterload and impaired left ventricular function compared to females.
- Recognizing sex differences in cardiovascular function is essential for tailoring diagnostic and therapeutic strategies in CD management.
Background:
Cushing disease (CD) may lead to accelerated cardiovascular remodeling and increased mortality. There are suspected differences in the mechanism of cardiovascular dysfunction between males and females with CD. The purpose of this study was to assess the effect of patient sex on the hemodynamic profile assessed via impedance cardiography and echocardiography in patients newly diagnosed with CD.
Material And Methods:
The 54 patients newly diagnosed with CD (mean age 41 years; 77.8% of females) who were included in this prospective clinical study underwent impedance cardiography to assess specific parameters (including systemic vascular resistance index [SVRI], total arterial compliance index [TACI], Heather index [HI], stroke index [SI], cardiac index [CI], velocity index [VI], and acceleration index [ACI]) and transthoracic echocardiography to assess heart chamber diameters and left ventricular systolic and diastolic function.
Results:
Males with CD exhibited higher afterload, with higher SVRI (3,169.3 ± 731.8 vs. 2,339.3 ± 640.8 dyn*s*cm-5*m² in males and females, respectively; p=0.002), lower TACI (0.80 ± 0.30 vs. 1.09 ± 0.30 mL/mmHg*m2; p=0.008), and lower hemodynamic parameters of left ventricular function, with lower HI (9.46 ± 2.86 vs. 14.1 ± 5.06 Ohm/s2; p=0.0007), lower VI (35.1 ± 11.9 vs. 44.9 ± 13.1 1*1000-1*s-1; p=0.009), lower SI (36.5 ± 11.7 vs. 43.6 ± 9.57 mL/m2; p=0.04), lower CI (2.36 ± 0.46 vs. 3.17 ± 0.76 mL*m-2*min-1; p=0.0009), and lower ACI (50.4 ± 19.8 vs. 73.6 ± 25.0 1/100/s2; p=0.006). There were no significant differences between the sexes in left ventricular systolic or diastolic function assessed by echocardiography.
Conclusion:
In comparison with females with CD, males with CD have a less favorable hemodynamic profile, with higher afterload and worse left ventricular function. Sex differences in cardiovascular system function should be taken into consideration in designing personalized diagnostic and therapeutic management of patients with CD.
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