Increased myocardial fibrosis and left ventricular dysfunction in Cushing's syndrome

• Published in: European journal of endocrinology Vol. 166; no. 1; pp. 27 - 34
• Main Authors: Yiu, Kai Hang, Ajmone Marsan, Nina, Delgado, Victoria, Biermasz, Nienke R, Holman, Eduard R, Smit, Johannes W A, Feelders, Richard A, Bax, Jeroen J, Pereira, Alberto M
• Format: Journal Article
• Language: English
• Published: Bristol BioScientifica 01.01.2012
• Subjects: Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathies - etiology; Cardiomyopathies - physiopathology; Cardiomyopathies - surgery; Clinical Study; Cushing Syndrome - complications; Cushing Syndrome - physiopathology; Cushing Syndrome - surgery; Echocardiography; Endocrinopathies; Female; Fibrosis - etiology; Fibrosis - physiopathology; Fibrosis - surgery; Fundamental and applied biological sciences. Psychology; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Hypertrophy, Left Ventricular - surgery; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - surgery; Vertebrates: endocrinology; Heart; Endocrinopathy; Myocardial fibrosis; Adrenal cortex diseases; Cushing syndrome; Cardiovascular disease; Heart ventricle; Hyperadrenocorticism; Left ventricular failure; Heart disease; Adrenal gland diseases; Circulatory system; Left ventricle performance; Endocrinology
• ISSN: 0804-4643; 1479-683X; 1479-683X
• DOI: 10.1530/EJE-11-0601

ObjectiveActive Cushing's syndrome (CS) is associated with cardiomyopathy, characterized by myocardial structural, and ultrastructural abnormalities. The extent of myocardial fibrosis in patients with CS has not been previously evaluated. Therefore, the objective of this study was to assess myocardial fibrosis in CS patients, its relationship with left ventricular (LV) hypertrophy and function, and its reversibility after surgical treatment.Design and methodsFifteen consecutive CS patients (41±12 years) were studied together with 30 hypertensive (HT) patients (matched for LV hypertrophy) and 30 healthy subjects. Echocardiography was performed in all patients including i) LV systolic function assessment by conventional measures and by speckle tracking-derived global longitudinal strain, ii) LV diastolic function assessment using E/E′, and iii) myocardial fibrosis assessment using calibrated integrated backscatter (IBS). Echocardiography was repeated after normalization of cortisol secretion (14±3 months).ResultsCS patients showed the highest value of calibrated IBS (−15.1±2.5 dB) compared with HT patients (−20.0±2.6 dB, P<0.01) and controls (−23.8±2.4 dB, P<0.01), indicating increased myocardial fibrosis independent of LV hypertrophy. Moreover, calibrated IBS in CS patients was significantly related to both diastolic function (E/E′, r=0.79, P<0.01) and systolic function (global longitudinal strain, r=0.60, P=0.02). After successful surgical treatment, calibrated IBS normalized (−21.0±3.8 vs −15.1±2.5 dB, P<0.01), suggestive of regression of myocardial fibrosis.ConclusionsPatients with CS have increased myocardial fibrosis, which is related to LV systolic and diastolic dysfunction. Successful treatment of CS normalizes the extent of myocardial fibrosis. Therefore, myocardial fibrosis appears to be an important factor in the development and potential regression of CS cardiomyopathy.