Session: SAT 26-40-Glucocorticoid Actions & Disease
Poster Board SAT-29
Objective:To investigate the impact of CS on cardiac structure and function by cMRI.
Design:Prospective case-control study in a tertiary referral endocrine center and cardiovascular imaging center.
Patients: Seventeen consecutive patients with newly diagnosed Cushing’s syndrome (16F/1M) and 17 age and sex-matched normontensive volunteers were studied. Patient’s median 24-hour urine free cortisol excretion was 371 μg/24h (range 102-3205).
Results: BMI, systolic blood pressure and heart rate were higher in patients with CS, whereas body surface area and diastolic blood pressure were not different between the groups. Compared to controls, patients had similar median end-diastolic LV volumes but decreased LV stroke volumes (67 mL vs 81 mL, P=0.02) and ejection fractions (52% vs 66%, P<0.001) with increased end-systolic volumes (P=0.01), indicative of reduced systolic LV performance. Both end-diastolic and end-systolic left atrial (LA) volumes were comparable between groups but LA ejection fraction was markedly reduced in patients compared to controls (64% vs 113%, P<0.001) pointing to severe diastolic LV dysfunction. Right ventricular parameters were comparable to LV determinants with increased end-systolic volumes (P=0.004), reduced stroke volumes (61 mL vs 76 mL, P=0.004) and ejection fraction (48% vs 62%, P<0.001). End-diastolic LV segmental thickness was increased in patients compared to controls in the basal (11.7 vs 7.9 mm, P<0.0001), mid-LV (10.7 vs 7.0 mm, P<0.0001) and apical (9.0 vs6.1 mm, P<0.0001) short axis planes, demonstrating global LV hypertrophy. This was not due to increased LV after-load since the proximal aortic stiffness was not different between the groups. One patient had dilated cardiomyopathy with normal coronary angiography and deeply altered LV systolic function (EF < 30%). Delayed gadolinium enhancement indicated myocardial fibrosis in 3 patients.
Conclusion: Patients with Cushing’s syndrome present with global cardiac hypertrophy associated with significantly reduced systolic performance and diastolic dysfunction of the left and right ventricles, compensated by higher heart rate. Reversibility of these observations is currently being evaluated.
Nothing to Disclose: PK, AR, CR, SS, LM, CJ, CA, ZR, AA, JY, NK, SB, EM, PC
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