Cardiac disease in Cushing’s syndrome. Emphasis on the role of cardiovascular magnetic resonance imaging

• Published in: Endocrine Vol. 83; no. 3; pp. 548 - 558
• Main Authors: Moustaki, Melpomeni, Markousis-Mavrogenis, George, Vryonidou, Andromachi, Paschou, Stavroula A., Mavrogeni, Sophie
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2024; Springer Nature B.V
• Subjects: Adipose tissue; Adrenocorticotropic hormone; Angiotensin; Angiotensin II; Cardiomyopathy; Cardiovascular disease; Cardiovascular diseases; Congestive heart failure; Coronary artery disease; Diabetes; Diabetes mellitus; Echocardiography; Endocrinology; Fibrosis; Glucocorticoid receptors; Glucocorticoids; Heart diseases; Humanities and Social Sciences; Hyperlipidemia; Hypertrophy; Internal Medicine; Magnetic resonance imaging; Medicine; Medicine & Public Health; Microvasculature; Morbidity; Mortality; multidisciplinary; Nervous system diseases; Phenotypes; Pituitary; Receptor mechanisms; Remission; Remission (Medicine); Review; Science; Subclinical heart failure; Cardiomyopathy; Cushing’s Syndrome; Cardiac magnetic resonance imaging; Coronary microvascular disease; Left ventricular hypertrophy
• ISSN: 1559-0100; 1355-008X; 1559-0100
• DOI: 10.1007/s12020-023-03623-0

Background
Cushing’s Syndrome (CS) is associated with increased cardiovascular morbidity and mortality. In endogenous CS, cardiovascular mortality remains increased for up to 15 years post remission of hypercortisolism. Similarly, patients with exogenous CS have 4-fold increased incidence of cardiovascular events, regardless of pre-existing cardiovascular disease (CVD).
Objective
To present the pathophysiology, prognosis, clinical and imaging phenotype of cardiac disease in CS.
Methods
A Pubmed search for cardiac disease in CS over the last 20 years was conducted using combinations of relevant terms. Preclinical and clinical studies, as well as review papers reporting on subclinical heart failure (HF), cardiomyopathy, coronary heart disease (CHD), and cardiovascular imaging were selected.
Results
Cardiac disease in CS is associated with direct mineralocorticoid and glucocorticoid receptor activation, increased responsiveness to angiotensin II, ectopic epicardial adiposity, arterial stiffness and endothelial dysfunction, as well as with diabetes mellitus, hypertension, hyperlipidemia, obesity and prothrombotic diathesis. Subclinical HF and cardiomyopathy are principally related to direct glucocorticoid (GC) effects and markedly improve or regress post hypercortisolism remission. In contrast, CHD is related to both direct GC effects and CS comorbidities and persists post cure. In patients without clinical evidence of CVD, echocardiography and cardiac magnetic resonance (CMR) imaging reveal left ventricular hypertrophy, fibrosis, diastolic and systolic dysfunction, with the latter being underestimated by echocardiography. Finally, coronary microvascular disease is encountered in one third of cases.
Conclusion
Cardiovascular imaging is crucial in evaluation of cardiac involvement in CS. CMR superiority in terms of reproducibility, operator independency, unrestricted field of view and capability of tissue characterisation makes this modality ideal for future studies.