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CLINICAL RESEARCH: CARDIAC FINDINGS IN CUSHING'S SYNDROME

Left ventricular structural and functional characteristics in Cushing’s syndrome

Maria Lorenza Muiesan, MD^*,*, Mario Lupia, MD, Massimo Salvetti, MD^*, Consuelo Grigoletto, MD, Nicoletta Sonino, MD, Marco Boscaro, MD, Enrico Agabiti Rosei, MD^*, Franco Mantero, MD and Francesco Fallo, MD^¶

^* Department of Medical and Surgical Sciences, Internal Medicine, University of Brescia, Brescia, Italy
Cardiology, Padova, Italy
Endocrinology, Padova, Italy
Medical Therapeutics Divisions, University of Padova, Padova, Italy
^¶ Endocrinology Division, University of Ancona, Ancona, Italy

Manuscript received November 26, 2002; revised manuscript received March 3, 2003, accepted March 20, 2003.

^* Reprint requests and correspondence: Prof. Maria Lorenza Muiesan, Department of Medical and Surgical Sciences, University of Brescia, c/o 2^a Medicina, Spedali Civili, 25100, Brescia, Italy.
muiesan{at}med.cci.unibs.it

OBJECTIVES: This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing’s syndrome.

BACKGROUND: A high prevalence of LV hypertrophy and concentric remodeling has been reported in Cushing’s syndrome, although no data have been reported on LV systolic and diastolic function.

METHODS: Forty-two consecutive patients with Cushing’s syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow.

RESULTS: The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing’s syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 ± 3% vs. 21 ± 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p < 0.001, respectively).

CONCLUSIONS: In patients with Cushing’s syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.

Abbreviations and Acronyms   BP = blood pressure   ESS = end-systolic stress   FS = fractional shortening   LV = left ventricle/ventricular   LVMI = left ventricular mass index   RWT = relative wall thickness

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