Cardiac dysfunction is reversed upon successful treatment of Cushing's syndrome

Abstract

Objective: In patients with active Cushing's syndrome (CS), cardiac structural and functional changes have been described in a limited number of patients. It is unknown whether these changes reverse after successful treatment. We therefore evaluated the changes in cardiac structure and dysfunction after successful treatment of CS, using more sensitive echocardiographic parameters (based on two-dimensional strain imaging) to detect subtle changes in cardiac structure and function. Methods: In a prospective study design, we studied 15 consecutive CS patients and 30 controls (matched for age, sex, body surface area, hypertension, and left ventricular (LV) systolic function). Multidirectional LV strain was evaluated by two-dimensional speckle tracking strain imaging. Systolic (radial thickening, and circumferential and longitudinal shortening) and diastolic (longitudinal strain rate at the isovolumetric relaxation time (SR IVRT )) parameters were measured. Results: At baseline, CS patients had similar LV diameters but had significantly more LV hypertrophy and impaired LV diastolic function, compared to controls. In addition, CS patients showed impaired LV shortening in the circumferential (K16.5G3.5 vs K19.7G3.4%, PZ0.013) and longitudinal (K15.9G1.9 vs K20.1G2.3%, P!0.001) directions and decreased SR IVRT (0.3G0.15 vs 0.4 G0.2/ s, PZ0.012) compared to controls. After normalization of corticosteroid excess, LV structural abnormalities reversed, LV circumferential and longitudinal shortening occurred, and SR IVRT normalized. Conclusion: CS induces not only LV hypertrophy and diastolic dysfunction but also subclinical LV systolic dysfunction, which reverses upon normalization of corticosteroid excess.

Metabolic comorbidities in Cushing's syndrome

“…After remission of hypercortisolism, LV mass parameters improved considerably but did not normalize completely (184). In a previous paper, echocardiographic assessment of CD patients revealed LV hypertrophy and diastolic dysfunction as well as subclinical LV systolic dysfunction, which reversed after remission (185). Using cardiac MRI, subclinical systolic biventricular and left atrial (LA) systolic dysfunction associated with increased LV mass was found in CS patients compared to the controls.…”

Cardiac hypertrophy in Cushing’s syndrome: if not hypertension then what?

“…Overall, this study adds to the scenario that the observed heart abnormalities in patients with CS are not directly related to blood pressure, and other contributing factors have to be considered. In this line, the reversibility of the structural changes did not relate to changes in blood pressure after treatment in two studies [8,9] and, also, hypertension does not seem to be an independent risk factor for long-term mortality in Cushing's disease [4].…”

“…The existing evidence, mainly from studies using echocardiography [5][6][7][8], suggests that patients with CS have increased prevalence of left ventricular (LV) hypertrophy, higher frequency of concentric remodeling, and LV systolic and diastolic dysfunction. LV mass index, however, is likely to be overestimated in echo-based studies.…”

“…Nevertheless, the increased LV mass and the concentric LV remodeling are independent risk factors for overt heart failure and major cardiovascular events. Of note, some of these abnormalities, such as circumferential and longitudinal LV hypertrophy, biventricular systolic function, diastolic LV dysfunction and LA systolic dysfunction, are reversible after treatment [8,9]. However, the pathophysiology of these heart abnormalities remains largely elusive.…”

Symptomatology of Cushing’s syndrome

“…Jak wykazali Toya i wsp. i Pareira i wsp., leczenie radykalne ZC i normalizacja poziomu kortyzolu powoduje u więk-szości chorych wycofanie się zmian strukturalnych serca [24,25].…”