The Coronary Artery Calcium Score as Prognostic Tool for Cardiovascular Events in Patients with Cushing's Syndrome

Area of Science:

• Cardiology
• Endocrinology
• Radiology

Background:

• Cushing's syndrome (CS) significantly elevates cardiovascular morbidity and mortality.
• No established screening tool exists to predict individual cardiovascular event risk in CS patients.
• Nonenhanced electron-beam computed tomography (CT) with Coronary Artery Calcium (CAC) scoring offers a potential non-invasive method.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the Agatston score (CAC score) in predicting cardiac events in patients with endogenous Cushing's syndrome.
• To compare the predictive value of CAC scores in CS patients with data from the Heinz Nixdorf Recall (HNR) study.
• To explore correlations between CAC score and markers of cortisol excess.

Main Methods:

• A prospective, single-center study involving 34 patients diagnosed with endogenous CS.
• Multidetector CT scans were performed at diagnosis to calculate CAC scores.
• Cardiovascular events were documented during a median 5-year follow-up period.

Main Results:

• CAC scores were significantly higher in CS patients who experienced cardiovascular events compared to those who did not (117 vs. 90, p<0.01).
• A CAC score exceeding the 75th risk factor-specific reference percentile yielded an odds ratio of 31.7 for cardiovascular events in CS patients (p=0.03).
• This predictive value was substantially higher than the odds ratio observed in the HNR study (4.5, p<0.01).

Conclusions:

• A CAC score above the 75th risk factor-specific reference percentile serves as a valuable screening tool for precise cardiovascular risk assessment in Cushing's syndrome.
• No significant correlation was found between the degree of cortisol excess and CAC score.
• CAC scoring demonstrates utility in stratifying cardiac risk in CS patients, aiding clinical management.