Cardiac structure and function in Cushing's syndrome: a cardiac magnetic resonance imaging study

Peter Kamenický, Alban Redheuil, Charles Roux, Sylvie Salenave, Nadjia Kachenoura, Zainab Raissouni, Laurent Macron, Laurence Guignat, Christel Jublanc, Arshid Azarine, Sylvie Brailly, Jacques Young, Elie Mousseaux, Philippe Chanson, Peter Kamenický, Alban Redheuil, Charles Roux, Sylvie Salenave, Nadjia Kachenoura, Zainab Raissouni, Laurent Macron, Laurence Guignat, Christel Jublanc, Arshid Azarine, Sylvie Brailly, Jacques Young, Elie Mousseaux, Philippe Chanson

Abstract

Background: Patients with Cushing's syndrome have left ventricular (LV) hypertrophy and dysfunction on echocardiography, but echo-based measurements may have limited accuracy in obese patients. No data are available on right ventricular (RV) and left atrial (LA) size and function in these patients.

Objectives: The objective of the study was to evaluate LV, RV, and LA structure and function in patients with Cushing's syndrome by means of cardiac magnetic resonance, currently the reference modality in assessment of cardiac geometry and function.

Methods: Eighteen patients with active Cushing's syndrome and 18 volunteers matched for age, sex, and body mass index were studied by cardiac magnetic resonance. The imaging was repeated in the patients 6 months (range 2-12 mo) after the treatment of hypercortisolism.

Results: Compared with controls, patients with Cushing's syndrome had lower LV, RV, and LA ejection fractions (P < .001 for all) and increased end-diastolic LV segmental thickness (P < .001). Treatment of hypercortisolism was associated with an improvement in ventricular and atrial systolic performance, as reflected by a 15% increase in the LV ejection fraction (P = .029), a 45% increase in the LA ejection fraction (P < .001), and an 11% increase in the RV ejection fraction (P = NS). After treatment, the LV mass index and end-diastolic LV mass to volume ratio decreased by 17% (P < .001) and 10% (P = .002), respectively. None of the patients had late gadolinium myocardial enhancement.

Conclusion: Cushing's syndrome is associated with subclinical biventricular and LA systolic dysfunctions that are reversible after treatment. Despite skeletal muscle atrophy, Cushing's syndrome patients have an increased LV mass, reversible upon correction of hypercortisolism.

Figures

Figure 1.
Figure 1.
Comparison of LV ejection fractions (A), LV stroke volume indexes (B), RV ejection fractions (C), RV stroke volume indexes (D), and LA ejection fractions between control subjects and Cushing's syndrome patients before and after treatment. Pre T, before treatment; post T, after treatment.
Figure 2.
Figure 2.
Comparison of LV mass indexes (A), LV mass to end-diastolic volume ratios (B), basal wall thickness (C), midventricular wall thickness (D), and apical wall thickness (E) in control subjects and Cushing's syndrome patients before and after treatment. Pre T, before treatment; post T, after treatment.
Figure 3.
Figure 3.
Steady-state free precession cine end-diastolic and end-systolic short- and long-axis images before and after treatment of Cushing's syndrome in patient 16 compared with a matched control subject. Note the global LV wall thickening without end-diastolic LV or RV dilatation and the decreased biventricular ejection in this symptomatic patient (NYHA II-III) prior to treatment and the clear reversal of this phenotype after treatment.

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