The impact of hypercortisolism beyond metabolic syndrome on left ventricular performance: a myocardial work analysis

Area of Science:

• Cardiology
• Endocrinology
• Echocardiography

Background:

• Endogenous Cushing's syndrome (CS) presents significant cardiovascular (CV) and metabolic risks.
• The specific impact of hypercortisolism on myocardial function remains incompletely understood.
• Myocardial Work (MW) analysis offers a novel echocardiographic approach to assess cardiac performance independently of afterload.

Purpose of the Study:

• To evaluate left ventricular (LV) performance using MW analysis in patients with overt endogenous CS and in long-term remission (CS-LTR).
• To compare MW parameters between CS patients, healthy subjects, and individuals with metabolic syndrome.
• To determine if MW alterations persist in CS-LTR patients.

Main Methods:

• Cross-sectional study comparing four groups: overt CS (n=31), CS-LTR (n=49), healthy subjects (n=439), and metabolic syndrome (n=305).
• Myocardial Work analysis, utilizing LV pressure-strain loops, was performed.
• Statistical analyses were adjusted for age and sex.

Main Results:

• Both overt CS and CS-LTR groups showed worse CV risk and metabolic profiles than healthy subjects, but better than metabolic syndrome patients.
• Patients with overt CS and CS-LTR exhibited significantly higher Wasted Work compared to healthy individuals and those with metabolic syndrome (p < 0.01 and p < 0.05, respectively).
• Compromised Work Efficiency was observed in CS patients (p < 0.05).

Conclusions:

• Left ventricular performance is demonstrably compromised in overt CS, exceeding alterations seen in metabolic syndrome patients with similar CV risk factors.
• Myocardial function remains impaired even after achieving biochemical remission in the CS-LTR group.
• Myocardial Work analysis effectively detects subtle, clinically significant differences in myocardial involvement across different patient phenotypes.