Endocrine Abstracts (2017) 49 OC12.4 | DOI: 10.1530/endoabs.49.OC12.4

Subclinical cardiovascular system dysfunction in the patients with Cushing's disease

Przemyslaw Witek1, Beata Uzieblo-Zyczkowska2, Pawel Krzesinski2, Agnieszka Jurek2, Grzegorz Zielinski3, Andrzej Skrobowski3 & Grzegorz Gielerak3

1Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland; 2Department of Cardiology and Internal Medicine, Military Institute of Medicine, Warsaw, Poland; 3Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland.

Background: Hypercortisolism in Cushing’s disease (CD) is associated with high cardiovascular risk. Hemodynamic disturbances, especially excessive vasoconstriction and elevated blood pressure (BP), may contribute to accelerated myocardial remodeling. Early identification of subclinical left ventricular (LV) dysfunction may be crucial for optimizing treatment and reducing mortality in patients with CD.

Purpose: The aim of this study was to assess the hemodynamic function of cardiovascular system in three groups of patients: 1/ with CD (CD), 2/ with essential arterial hypertension (AH) and healthy volunteers (HV).

Methods: In 171 subjects (CD – 22, AH – 114, HV – 35), without any symptoms of heart failure, the echocardiographic assessment of LV systolic and diastolic function and non-invasive hemodynamic assessment by impedance cardiography (ICG) were performed. Statistical comparison included separate analysis for women and men.

Results: CD revealed good BP control (82% below 140/90 mmHg). However, in comparison to AH and HV they presented: 1) significantly lower LV contractility expressed by global longitudinal strain (GLS: −17.7% vs −19.2 vs −20.0; P=0.004); 2) higher prevalence of LV diastolic function (45.0% vs 14.2% vs 0.0%; P<0.00001); 3) lower impedance indices of LV performance: stroke index (SI: 39.8 vs 52.2 vs 49.9 ml/m2; P<0.00001) cardiac index (CI: 2.86 vs 3.54 vs 3.27 l/min/m2; P<0.0001) and 4) higher afterload: systemic vascular resistance index (SVRI: 2560 vs 1901 vs 1907 dyn*s*m2/cm5; P<0.0001). Men with CD distinguished with lower CI (P<0.00001) and SVRI (P<0.0001), as though worse LV diastolic function (e‘: P=0.0002; GLS: P=0.052). In women hypercortisolism was more related to impaired LV systolic function (GLS: P=0.010; e‘: NS).

Conclusions: Cushing’s disease, even with well-controlled BP, is associated with LV systolic and diastolic dysfunction and pronounced vasoconstriction which individual presentation depends on sex. These hemodynamic alterations can be detected by modern non-invasive diagnostic tools and became potential therapeutic objectives.

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