Impaired cardiac pumping function and increased afterload as determinants of early hemodynamic alterations in Cushing disease

Q: What are the key findings of this study?

In patients newly diagnosed with Cushing disease, higher left ventricular mass index was significantly associated with impaired cardiac pumping function and increased afterload, including lower total artery compliance.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cushing disease (n=54). Intervention: Impedance cardiography (ICG) hemodynamic assessment. Primary outcome: Correlation between left ventricular mass index (LVMI) and total artery compliance index (TACI) (R=-0.52, p=<0.001).

Q: What does this research mean for the field?

In patients newly diagnosed with Cushing disease, higher left ventricular mass index is significantly associated with impaired cardiac pumping function and increased afterload, including lower total artery compliance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Agnieszka Włochacz; Paweł Krzesiński; Beata Uziębło-Życzkowska; Przemysław Witek; Grzegorz Zieliński; A Kazimierczak; Robert Wierzbowski; Małgorzata Banak; Grzegorz Gielerak

doi:10.1038/s41598-024-84888-x

January 2, 2025Scientific ReportsOpen Access

Impaired cardiac pumping function and increased afterload as determinants of early hemodynamic alterations in Cushing disease

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Key result

Higher LVMI in Cushing disease is linked to impaired pumping function and increased afterload.

R=-0.52
P<0.001
n=54

Figures

Why the study?

Long-term hypercortisolemia in Cushing disease may lead to hemodynamic disorders by increasing subclinical cardiac and vascular dysfunction.

Study Design

Type

Cohort (n=54)

Multicenter

No

Structured PICO

P

Population

54 adult patients newly diagnosed with Cushing disease (CD), mean age 41 years, 77.8% female, 64.8% with well-controlled hypertension. Excluded: heart failure with LVEF <50%, chronic or acute coronary syndrome, clinically significant valvular disease, poorly controlled hypertension, history of pulmonary embolism, pulmonary hypertension, history of stroke or TIA, chronic kidney disease (eGFR <60), COPD, peripheral artery disease, and pregnancy.

O

Outcome

Relationship between hemodynamic parameters evaluated via impedance cardiography (ICG) and echocardiographic parameters reflecting left ventricular functionsurrogate

Main Result

Effect estimate: R=-0.52

p-value: p=<0.001

In patients newly diagnosed with Cushing disease, impaired left ventricular pumping function and increased afterload are detectable via impedance cardiography and correlate with echocardiographic signs of structural and diastolic dysfunction.

Limitations

Relatively small sample size due to the low incidence of ACTH-secreting pituitary neuroendocrine tumors
Exclusion of patients with clinically significant cardiovascular dysfunction and multiple comorbidities
Lack of a control group without Cushing disease

Implication

Supports early cardiac assessment in Cushing disease; hypothesis-generating for reversibility and outcomes.

Abstract

The long-term hypercortisolemia of Cushing disease (CD) may lead to hemodynamic disorders by increasing subclinical cardiac and vascular dysfunction. The purpose of this observational cohort study was to assess the relationship between hemodynamic parameters evaluated via impedance cardiography (ICG) and echocardiographic parameters reflecting left ventricular function in 54 patients newly diagnosed with CD. The parameters assessed via ICG included stroke volume index (SI), cardiac index (CI), acceleration index (ACI), velocity index (VI), systemic vascular resistance index (SVRI), total artery compliance index (TACI). The echocardiographic parameters included left ventricular mass index (LVMI) and left ventricular systolic and diastolic parameters. Higher LVMI values were associated with lower SI (p = 0.003), CI (p = 0.001), VI (p = 0.048), TACI (p < 0.001), and with higher SVRI (p < 0.001). Poorer parameters of left ventricular diastolic function corresponded to the parameters assessed via ICG: (1) lower ratio E/A was associated with lower SI (p = 0.002), VI (p = 0.001), ACI (p = 0.01), TACI (p = 0.001); (2) lower average e' was associated with lower SI (p = 0.017), CI (p = 0.009), VI (p = 0.004), TACI (p = 0.001), and with higher SVRI (p = 0.002); (3) higher ratio E/e' corresponded to lower TACI (p = 0.01). Decreased global longitudinal strain corresponded to lower TACI (p = 0.046). CD is associated with impaired pumping function of the heart and higher afterload.

Discussion

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Cite This Study

Włochacz et al. (2025) conducted a cohort in Cushing disease (n=54). Impedance cardiography (ICG) hemodynamic assessment was evaluated on Correlation between left ventricular mass index (LVMI) and total artery compliance index (TACI) (R=-0.52, p=<0.001). In patients newly diagnosed with Cushing disease, higher left ventricular mass index was significantly associated with impaired cardiac pumping function and increased afterload, including lower total artery compliance.

synapsesocial.com/papers/6a1aa9b849c6765e3885c554 https://doi.org/10.1038/s41598-024-84888-x

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Impaired cardiac pumping function and increased afterload as determinants of early hemodynamic alterations in Cushing disease

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Impaired cardiac pumping function and increased afterload as determinants of early hemodynamic alterations in Cushing disease

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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