Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma

Abstract

BackgroundMajority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group.ObjectiveIn this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI.MethodsThirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant.ResultsLeft ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups.ConclusionOur study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Markers of Subclinical Cardiovascular Disease in Patients with Adrenal Incidentaloma

“…The number of publications on echocardiographic measurements among AI patients is limited. The few available studies confirmed the presence of left ventricular hypertrophy features in this subject group: increased left ventricular EDD and ESD, IVSd, PWd, or LVMI [55,58,64,[79][80][81][82]. Left ventricular diastolic dysfunction usually precedes myocardial hypertrophy, thus being an early indicator of micro-and macrocirculatory disorders.…”

“…In AI patients, both mean LVMI and incidence of LVH was higher in pACS than in the NFAI group [64]. Sokmen G. et al in a group of 30 patients with NFAI also found significantly higher LVMI, IVSd, and Pwd, as compared to the control group [82].…”

“…AI patients had impaired left ventricular relaxation demonstrated by decreased E/A ratio and prolonged IVRT [58]. One of the studies also demonstrated decreased E/A ratio in NFAI patients, but the level of statistical significance was not reached (p = 0.07) [82]. Additionally, among AI patients, higher EFT volume was shown, probably being a new risk factor for metabolic syndrome and cardiovascular disease [56,80,81].…”

Abnormal body composition in patients with adrenal adenomas

“…Lopez et al showed that patients with NFAT had a significantly higher risk of developing incident composite diabetes (19). Patients with NFAT were found to have altered ventricular echocardiographic findings, increased intra-and inter-atrial conduction times, greater carotid intima media thickness, and increased aortic stiffness (38,39,40). The observed body composition changes in our study and reported cardiovascular risk in other studies may be explained by the abnormal cortisol secretion not detected by the currently available diagnostic tests or by the underlying abnormal steroid metabolome in patients with NFAT (41,42,43,44).…”

Nonfunctioning Adrenal Incidentalomas: The Search for Subclinical Cardiac Alterations

“…In this issue of Arquivos Brasileiros de Cardiologia , Sokmen et al. 2 selected patients (Pts) following the European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. After confirming the presence of an adrenal adenoma through imaging tests, computed tomography, or magnetic resonance imaging, they excluded Cushing Syndrome through 1-mg dexamethasone suppression test (DST), pheochromocytoma by urinary fractionated metanephrine test, and primary aldosteronism.…”