Cushing's Disease: Subclinical Left Ventricular Systolic and Diastolic Dysfunction Revealed by Speckle Tracking Echocardiography and Tissue Doppler Imaging.

OBJECTIVE: Novel echocardiographic techniques, such as speckle tracking echocardiography (STE) and tissue Doppler imaging, are sensitive tools for assessing left ventricular (LV) performance. LV global longitudinal strain (GLS), assessed by STE, is a sensitive marker of myocardial systolic function. Cardiovascular complications in patients with Cushing's disease (CD) determine a higher mortality than that in an age- and gender-matched population. Cardiac systolic dysfunction may be detected in early stages by STE. Thus, the aim of this study was to investigate the usefulness of STE in detecting subclinical LV dysfunction in three groups of patients: CD group, arterial hypertension group (AHG), and healthy volunteers (HV).

METHODS: Echocardiographic assessments of LV systolic and diastolic function were performed in 171 subjects (CD: 22, AHG: 114, HV: 35) with no symptoms of heart failure. A statistical comparison included separate analyses for men and women.

RESULTS: CD patients showed good blood pressure (BP) control (below 140/90 mmHg in 82% of cases). However, in comparison AHG and HV groups they exhibited: (1) significantly lower LV contractility expressed by GLS (CD group: -17.7%, AHG group: -19.2%, HV: -20.0%; p = 0.004) and (2) higher prevalence of LV diastolic dysfunction (45.0, 14.2, 0.0%, respectively; p < 0.00001). Men with CD showed significantly more pronounced LV diastolic dysfunction. Cortisol excess in women was related to impaired LV systolic function.

CONCLUSION: CD, even with well-controlled BP, is associated with LV dysfunction which depends individually on sex. These hemodynamic alterations can be detected by modern non-invasive diagnostic tools and may become potential therapeutic objectives.