title: Cardiac structure and function in Cushing's syndrome: a cardiac magnetic resonance imaging study.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculté de Médecine (P.K., S.S., S.B., J.Y., P.C.), Univ Paris-Sud, F-94276 Le Kremlin Bicêtre, France; Faculté de Médecine (A.R., N.K.), Sorbonne Universités, Université Pierre et Marie Curie Univ Paris 06, F75006 Paris, France; Faculté de Médecine (E.M.), Université Paris Descartes, F75006 Paris, France; Service d'Endocrinologie et des Maladies de la Reproduction (P.K., S.S., J.Y., P.C.) and Service de Pharmacogénétique (S.B.), Biochimie Moléculaire et Hormonologie, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, F-94275 Le Kremlin Bicêtre, France; Département d'Imagerie Cardiovasculaire (A.R.) and Service d'Endocrinologie (C.J.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, F75013 Paris, France; Service de Radiologie Cardiovasculaire (C.R., L.M., A.A., Z.R., E.M.), Hôpital Européen George Pompidou, Assistance Publique-Hôpitaux de Paris, F75015 Paris, France; Service d'Endocrinologie (L.G.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, F75006 Paris, France; U693 (P.K., J.Y., S.B., P.C.), Institut National de la Santé et de la Recherche Médicale (INSERM), F-94276 Le Kremlin Bicêtre, France; Unité Mixte de Recherche 7371 and Unité Mixte de Recherche en Santé 1146 (A.R., N.K.), Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, INSERM, F-75013 Paris, France.
authors.forename: Peter
authors.initials: P
authors.lastname: Kamenický
authors.forename: Alban
authors.initials: A
authors.lastname: Redheuil
authors.forename: Charles
authors.initials: C
authors.lastname: Roux
authors.forename: Sylvie
authors.initials: S
authors.lastname: Salenave
authors.forename: Nadjia
authors.initials: N
authors.lastname: Kachenoura
authors.forename: Zainab
authors.initials: Z
authors.lastname: Raissouni
authors.forename: Laurent
authors.initials: L
authors.lastname: Macron
authors.forename: Laurence
authors.initials: L
authors.lastname: Guignat
authors.forename: Christel
authors.initials: C
authors.lastname: Jublanc
authors.forename: Arshid
authors.initials: A
authors.lastname: Azarine
authors.forename: Sylvie
authors.initials: S
authors.lastname: Brailly
authors.forename: Jacques
authors.initials: J
authors.lastname: Young
authors.forename: Elie
authors.initials: E
authors.lastname: Mousseaux
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
mesh_terms: D000293:Adolescent; D000328:Adult; D003480:Cushing Syndrome / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D013318:Stroke Volume / Q000502:physiology*; D055815:Young Adult
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