title: Clinical relevance of cardiac structure and function abnormalities in patients with Cushing's syndrome before and after cure.
abstract: OBJECTIVE
  Sustained hypercortisolism impacts cardiac function, and, indeed, cardiac disease is one of the major determinants of mortality in patients with Cushing's syndrome. The aim of this study was to assess the clinical relevance of cardiac structure and function alterations by echocardiography in patients with active Cushing's syndrome and after disease remission.
  
  
  METHODS
  Seventy-one patients (61 women, 10 men) with Cushing's syndrome and 70 age-, sex- and blood pressure-matched controls were enrolled. Echocardiography was performed in 49 patients with active disease and at several time points after remission in 44 patients (median follow-up 46.4 months), and prevalence of abnormal left ventricular mass measurements and systolic and diastolic functions indices was compared between patients with active disease, after remission and controls. Twenty-two patients were evaluated both before and after remission.
  
  
  RESULTS
  Up to 70% of patients with active Cushing's syndrome presented abnormal left ventricular mass parameters; 42% presented concentric hypertrophy and 23% concentric remodelling. Major indices of systolic and diastolic functions, i.e. ejection fraction and E/A ratio, respectively, were normal. Upon remission of hypercortisolism, left ventricular mass parameters ameliorated considerably, although abnormal values were still more frequent than in controls. Both cortisol excess and hypertension contribute to cardiac mass alterations and increase the prevalence of target organ damage.
  
  
  CONCLUSIONS
  Cushing's syndrome is associated with an increased risk for abnormalities of cardiac mass, which ameliorates, but does not fully disappear after remission. Systolic and diastolic functions are largely within the normal range in these patients.
authors.affiliation: Ospedale San Luca, Neuroendocrinology Research Lab, Istituto Auxologico Italiano IRCCS, Via Zucchi 18, Cusano Milanino, Milan, Italy.
authors.forename: Paola M
authors.initials: PM
authors.lastname: Toja
authors.forename: Giovanna
authors.initials: G
authors.lastname: Branzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciambellotti
authors.forename: Piero
authors.initials: P
authors.lastname: Radaelli
authors.forename: Martina
authors.initials: M
authors.lastname: De Martin
authors.forename: Laura Maria
authors.initials: LM
authors.lastname: Lonati
authors.forename: Massimo
authors.initials: M
authors.lastname: Scacchi
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavagnini
authors.forename: Francesca
authors.initials: F
authors.lastname: Pecori Giraldi
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003480:Cushing Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D003971:Diastole; D004452:Echocardiography / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D009206:Myocardium / Q000473:pathology*; D012074:Remission Induction; D013599:Systole; D013997:Time Factors