Cardiomyopathy in Cushing's syndrome revisited by cardiac magnetic resonance imaging

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 26-40-Glucocorticoid Actions & Disease
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-29
Peter Kamenickż**1, Alban Redheuil*2, Charles Roux2, Sylvie Salenave1, Laurent Macron2, Christel Jublanc3, Christiane Ajzenberg4, Zainab Raissouni2, Arshid Azarine2, Jacques Young1, Nadjia Kachenoura5, Sylvie Brailly-Tabard1, Elie Mousseaux2 and Philippe Chanson1
1CHU de BicÍtre, APHP, Le Kremlin BicÍtre, France, 2HEGP, APHP, Paris, France, 3CHU Pitiť-SalpÍtriŤre, APHP, Paris, France, 4CHU Henri Mondor, APHP, Creteil, France, 5UMR_S 678, INSERM, Paris, France
Background:Cardiomyopathy in Cushing’s syndrome (CS) has been evaluated in few echocardiograpic studies showing left ventricular (LV) remodeling and dysfunction, but has not yet been analyzed by cardiac magnetic resonance imaging (cMRI), currently presenting the gold standard in heart imaging.

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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