title: Specific electrocardiographic features associated with Cushing's disease.
abstract: OBJECTIVE
  Hypercortisolaemia is associated with an increased risk of cardiovascular disease (CVD), either through a direct action on the myocardium or by increased traditional cardiovascular risk factors. The aim of this study was to investigate whether the alterations in the ECG in Cushing's disease (CD) are predictable from risk factor analysis alone.
  
  
  METHODS
  In 79 patients with a diagnosis of CD, retrospectively recruited, ECG features [corrected for heart rate QT (QTc), QTc dispersion (QTcd), left ventricular hypertrophy (ECG-LVH), right ventricular hypertrophy (ECG-RVH)], systolic (SBP) and diastolic (DBP) blood pressure were assessed. Biochemical, hormonal (cortisol at 09·00 h or cortisol day curve, CDC) and carbohydrate abnormalities (CHA), history of hypertension and cardiovascular disease were recorded. For comparison reasons, a group of 42 healthy subjects matched for gender, age and body mass index previously subjected to ECG assessment were selected.
  
  
  RESULTS
  In patients with CD, we noted the following prevalence: metabolic syndrome 39%, hypertension 81%, CVD 21·5%, hypercholesterolaemia 37%, hypertriglyceridaemia 29%, CHA 41%, but a history of cardiac dysrhythmia was only noted in a single patient. No difference in QTc or QTcd was shown between patients with normal or low potassium levels. QTcd >50 ms was associated with both increased ECG-LVH and ECG-RVH. When compared to the control group, patients had longer QTcd (P < 0·001), more prevalent LVH (P < 0·001) and RVH (P = 0·001), and higher SBP and DBP (P < 0·001), but similar QTc. Both CD and ECG evidence of LVH predicted prolonged QTcd, but the association of CD with a prolonged QTcd was independent of other risk factors, including hypertension.
  
  
  CONCLUSIONS
  Prolonged QTcd in association with ECG evidence of LVH appears to be the specific feature of CD. This may be relevant in the choice of medical therapy for CD and for consideration of treatment of the comorbidities that are associated with hypercortisolaemia.
authors.affiliation: Department of Endocrinology, St Bartholomew's Hospital, London, UK.
authors.forename: Krystallenia I
authors.initials: KI
authors.lastname: Alexandraki
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Kaltsas
authors.forename: Apostolos-Ilias
authors.initials: AI
authors.lastname: Vouliotis
authors.forename: Theodoros G
authors.initials: TG
authors.lastname: Papaioannou
authors.forename: Lauren
authors.initials: L
authors.lastname: Trisk
authors.forename: Athanasios
authors.initials: A
authors.lastname: Zilos
authors.forename: Márta
authors.initials: M
authors.lastname: Korbonits
authors.forename: G Michael
authors.initials: GM
authors.lastname: Besser
authors.forename: Aris
authors.initials: A
authors.lastname: Anastasakis
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Grossman
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases; D016022:Case-Control Studies; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia; D006973:Hypertension; D015228:Hypertriglyceridemia; D017379:Hypertrophy, Left Ventricular; D017380:Hypertrophy, Right Ventricular; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000150:complications* / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors