Cardio-metabolic risk in Cushing’s syndrome patients: a study of cardiac magnetic resonance imaging

D. De Alcubierre*^a (Dr), A. Cozzolino^a (Dr), T. Feola^a (Dr), R. Pofi^a (Dr), N. Di Paola^b (Dr), N. Galea^c (Dr), MC. De Martino^b (Dr), E. Giannetta^a (Prof), R. Pivonello^b (Prof), AM. Isidori^a (Prof)

^a Department of Experimental Medicine, Sapienza University of Rome, Rome, ITALY ; ^b Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università degli Studi di Napoli “Federico II”, Naples, ITALY ; ^c Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, ITALY

* dario.dealcubierre@uniroma1.it

Introduction: Cardiovascular disease is a major cause of death in patients with Cushing’s syndrome (CS), either during active disease or after remission. Cardiac magnetic resonance (CMR) is currently regarded as the gold standard method for measuring structural and functional changes, with higher interstudy reproducibility and lower variability compared to 2-D echocardiography. In the present study, we aimed to investigate the metabolic profile and to detect the cardiac alterations though CMR in CS patients.

Materials and methods: This was a prospective multicentric case-control study. Consecutive patients with CS both cured and with active disease, screened in the ERGO study (EudraCT number: 2015-004497-15) by two Italian referral centers, were enrolled. The control group consisted of sex, age, and BMI matched patients with non-functioning adrenal incidentaloma. Metabolic, clinical and cardiac parameters evaluated though CMR were assessed and compared in the two groups. Parametric and non-parametric tests were performed, as appropriate.

Results: Sixteen patients with CS (12 females, 4 males) with a mean age of 48 years (range 20-71 years) and 9 matched controls entered the study. Fasting glucose levels were significantly lower in CS patients than controls (p=0.003), whereas no significant differences were found neither in lipid levels, in systolic and diastolic blood pressure levels, nor in the prevalence of cardiometabolic complications. LV end-systolic volume (LV-ESV) and LV-ESV indexed to the body surface (LV-ESVi) were significantly higher in CS patients than controls (p=0.041; p=0.030). Right ventricle end-diastolic volume (RV-EDV), RV-EDVi, RV-ESV and RV-ESVi were significantly higher in CS patients than controls (p=0.025; p=0.033; p=0.004; p=0.008), with a trend toward lower RV-EF in patients than controls (p=0.067).

Conclusions: CS patients present with biventricular cardiac structural and functional impairment at CMR, which seem to derive from a direct effect of hormone excess, determining changes in cardiac muscle, independently from the presence of disease-related cardiovascular risk factors (such as hypertension, visceral obesity, metabolic impairment), which role need further investigations. Our study suggests that CMR may have a place in the cardiac work-up of selected patients with CS.

The author has declared no conflict of interest.