Key result
Cushing's disease was independently associated with prolonged QTc dispersion (P<0.001) and more prevalent left ventricular hypertrophy (P<0.001) compared to matched healthy controls.
Why the study?
Does Cushing's disease alter ECG features independently of traditional cardiovascular risk factors compared to healthy controls?
Case-Control (n=121)
Does Cushing's disease alter ECG features independently of traditional cardiovascular risk factors compared to healthy controls?
Cushing's disease is independently associated with prolonged QTc dispersion and ECG evidence of left ventricular hypertrophy, which may inform medical therapy and comorbidity management.
Cushing's disease patients may warrant ECG monitoring; leaves open prognostic value and treatment effects.
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. DESIGN: 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.
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Alexandraki et al. (2011) conducted a case-control in Cushing's disease (n=121). Cushing's disease vs. Healthy subjects matched for gender, age and body mass index was evaluated on ECG features (QTcd, LVH, RVH) and blood pressure (p=<0.001). Cushing's disease was independently associated with prolonged QTc dispersion (P<0.001) and more prevalent left ventricular hypertrophy (P<0.001) compared to matched healthy controls.
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