Coronary microvascular function in patients with Cushing’s syndrome

Abstract

The aim of the study was to evaluate patients with Cushing's syndrome the coronary flow reserve (CFR), an index of coronary microvascular function. Fifteen newly diagnosed patients with Cushing's syndrome (1 male/14 females; mean age 45 ± 11 years), were selected for having no clinical evidence of ischemic heart disease. Twelve patients had pituitary-dependent Cushing's disease and three had an adrenal adenoma. Fifteen subjects matched for age, sex, and major cardiovascular risk factors were used as controls. Coronary flow velocity in the left anterior descending coronary artery was investigated by transthoracic Doppler echocardiography at rest and during adenosine infusion. CFR was obtained as the ratio hyperemic/resting diastolic flow velocity. A reduced coronary reserve (hyperemic/resting ratio ≤ 2.5) was found in 5/15 Cushing patients and 4/15 controls. In all patients with abnormal CFR, epicardial coronary stenosis was excluded by multi-slice computed tomographic coronary angiography. CFR was inversely related to urinary cortisol in patients with endogenous hypercortisolism (Spearman's rho = -0.57, P = 0.03), while no correlation was found in controls. Coronary microvascular function, as assessed by CFR, is pathologically reduced in a considerable number of patients with Cushing's syndrome without clinical symptoms of ischemic heart disease and in the absence of epicardial coronary artery lesions, as well as in controls matched for cardiovascular risk factors. The presence of comorbidities can explain this early coronary abnormality in both patients and controls. Whether urinary cortisol may be a predictor of coronary microvascular function in the setting of patients with Cushing's syndrome, needs further investigation.

Metabolic comorbidities in Cushing's syndrome

“…Increased prevalence of coronary artery disease persists even after long-term remission of CS, since more coronary calcification and non-calcified plaques were found in cured CS patients than in age-and gender-matched controls (174). Coronary flow reserve is more commonly reduced in CS patients, compared to matched controls, and correlates negatively to urinary free cortisol (175).…”

Cardiac Structure and Function in Cushing's Syndrome: A Cardiac Magnetic Resonance Imaging Study

“…Patients with Cushing's syndrome are at increased risk of cardiovascular events, which does not fully normalize after remission (4–7). Increased blood pressure (BP), glucose intolerance or diabetes, central obesity, and metabolic syndrome (8) together with chronic hypokalemia (9) and a direct toxic effect of cortisol can all affect cardiac structure and function (2).…”

Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters

“…Coronary microvascular function, as assessed by CFR, is pathologically reduced in a considerable number of patients with Cushing's syndrome without clinical symptoms of ischemic heart disease and in the absence of epicardial coronary artery lesions [50]. Although the presence of comorbidities has to be taken into account to explain this early coronary abnormality in Cushing patients, CFR inversely relates to urinary cortisol in patients with endogenous hypercortisolism.…”