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Left ventricular structural characteristics in Cushing's syndrome
Insights
Long-term exposure to excess cortisol, not hormone levels or blood pressure, significantly impacts left ventricular remodeling in Cushing's syndrome patients. Echocardiography revealed normalized heart structure after successful treatment.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Cushing's syndrome is associated with cardiovascular complications.
- Left ventricular structural changes may occur in patients with Cushing's syndrome.
Purpose of the Study:
- To evaluate left ventricular structural characteristics using echocardiography in Cushing's syndrome patients.
- To compare these findings with a matched control population.
Main Methods:
- M-mode echocardiography was performed on 18 patients with Cushing's syndrome and 18 controls.
- Subjects were matched for sex, age, body weight, body surface area, blood pressure, and duration of hypertension.
- Relative wall thickness (RWT) and left ventricular mass index were assessed.
Main Results:
- Elevated RWT was observed in 11/18 Cushing's syndrome patients versus 2/18 controls.
- Left ventricular mass index was abnormal in 3/18 Cushing's syndrome patients and 4/18 controls.
- RWT correlated significantly with disease duration, not blood pressure or cortisol levels; normalization occurred post-surgery.
Conclusions:
- Prolonged exposure to elevated cortisol, rather than hormone levels or blood pressure, is the primary driver of left ventricular concentric remodeling in Cushing's syndrome.
- Echocardiography is valuable for assessing cardiac structural changes in Cushing's syndrome.
- Successful treatment can reverse cardiac remodeling.
Abstract:
The aim of the present study was to assess structural characteristics of the left ventricle by echocardiography in a group of patients with Cushing's syndrome compared with a control population. Eighteen patients with Cushing's syndrome and 18 controls, matched for sex, age, body weight, body surface area, blood pressure (BP) and duration of hypertension were investigated by M-mode (2-D derived) echocardiography. In each of the two groups, 11 of 18 subjects were hypertensive. Relative wall thickness (RWT) was above normal (> 0.45) in 11 (five normotensive and six hypertensive) of 18 patients with Cushing's syndrome and in two (hypertensive) of 18 controls. Left ventricular mass index was abnormal in three (one normotensive and two hypertensive) patients with Cushing's syndrome and in four hypertensive controls. All other systolic function indices were within normal and similar in both groups. No correlation was found between RWT and BP as well as between RWT and urinary cortisol levels in patients with Cushing's syndrome. A significant correlation was found between RWT and duration of disease. Echocardiography after successful surgery showed normalisation of RWT in five of six patients in whom it was previously abnormal. Our data suggest that time factor, i.e. long-lasting exposure to increased cortisol, rather than hormone or BP levels is the most relevant determinant of left ventricular concentric remodeling in patients with Cushing's syndrome.