Epicardial and pericardial adiposity without myocardial steatosis in Cushing’s syndrome

2021 ◽  
Author(s):  
Peter Wolf ◽  
Benjamin Marty ◽  
Khaoula Bouazizi ◽  
Nadjia Kachenoura ◽  
Céline Piedvache ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Fat Mass ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Epicardial Fat ◽  
Secondary Outcome ◽  
Pericardial Fat ◽  
Disease Remission ◽  
Dixon Method

Abstract Context Cardiovascular disease is the leading cause of death in patients with Cushing’s syndrome. Cortisol excess and adverse metabolic profile could increase cardiac fat, which can subsequently impair cardiac structure and function. Objective We aimed to evaluate cardiac fat mass and distribution in patients with Cushing’s syndrome. Design In this prospective cross-sectional study 23 patients with Cushing’s syndrome and 27 control subjects of comparable age, sex and body-mass-index were investigated by cardiac magnetic resonance imaging and proton spectroscopy. Patients were explored before and after biochemical disease remission. Outcome measures Myocardial fat measured by the Dixon method was the main outcome measure. The intramyocardial triglyceride/water ratio measured by spectroscopy and epicardial and pericardial fat volumes were secondary outcome measures. Results No difference was found between patients and controls in intramyocardial lipid content. Epicardial fat mass was increased in patients compared to controls (30.8g/m 2 [20.4;34.8] vs 17.2g/m 2 [13.1;23.5], p<0.0001). Similarly, pericardial fat mass was increased in patients compared to controls (28.3g/m 2 [17.9;38.0] vs 11.4g/m 2 [7.5;19.4], p=0.0035). Sex, HbA1c and presence of hypercortisolism were independent determinants of epicardial fat. Pericardial fat was associated with sex, impaired glucose homeostasis and left ventricular wall thickness. Disease remission decreased epicardial fat mass without affecting pericardial fat. Conclusions Intramyocardial fat stores are not increased in patients with Cushing’s syndrome, despite highly prevalent metabolic syndrome, suggesting increased cortisol-mediated lipid consumption. Cushing’s syndrome is associated with marked accumulation of epicardial and pericardial fat. Epicardial adiposity may exert paracrine proinflammatory effects promoting cardiomyopathy. Trial registration ClinicalTrials.gov, NCT02202902.

scholarly journals Reversible alterations in cardiac morphology and functions in a patient with Cushing's syndrome

2014 ◽  
Vol 2014 ◽  
Author(s):  
Hiroaki Iwasaki
Keyword(s):  
Cushing’S Syndrome ◽  
Interventricular Septum ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Multidetector Row Computed Tomography ◽  
List Type ◽  
Adrenocortical Adenoma ◽  
Cardiac Morphology ◽  
Free Cortisol

Summary A 45-year-old female was referred for endocrine evaluation of an incidental mass (31×24 mm in diameter) on the right adrenal gland. The patient was normotensive and nondiabetic, and had no history of generalised obesity (body weight, 46 kg at 20 years of age and 51.2 kg on admission); however, her waist-to-hip ratio was 0.97. Elevated urinary free cortisol levels (112–118 μg/day) and other findings indicated adrenocorticotrophic hormone-independent Cushing's syndrome due to right adrenocortical adenoma. Echocardiography before adrenalectomy revealed concentric left ventricular (LV) hypertrophy with a particular increase in interventricular septum thickness leading to impaired systolic and diastolic functions. Upon surgical remission of hypercortisolism, the asymmetric hypertrophy disappeared and the cardiac dysfunctions were considerably ameliorated. Although the mechanism(s) by which excessive cortisol contributes to LV wall thickness remain(s) unclear, serial echocardiography and cardiac multidetector-row computed tomography may support the notion that abnormal fat deposition in the myocardium owing to hypercortisolism appears to be an important factor for the reversible change in the cardiac morphology. Learning points Patients with Cushing's syndrome occasionally exhibit severe LV hypertrophy related to systolic and diastolic dysfunctions although they have neither hypertension nor diabetes mellitus. Biological remission of hypercortisolism can normalise structural and functional cardiac parameters and help in differentiating the cardiac alterations induced by excessive cortisol from those induced by other diseases. Excessive lipid accumulation within the heart before myocardial fibrosis may be implicated in reversible alterations in the cardiac morphology by Cushing's syndrome. Early diagnosis and treatment of Cushing's syndrome appear to be pivotal in preventing irreversible cardiac dysfunctions subsequent to cardiovascular events and heart failure.

scholarly journals 3266 Understanding epicardial adipose biology by imaging, transcriptomic, and lipidomic profiling

2019 ◽  
Vol 3 (s1) ◽  
pp. 157-158
Author(s):  
Jadranka Stojanovska ◽  
Alex Tsodikov ◽  
Carey Lumeng ◽  
Charles Burant ◽  
Thomas Chenevert
Keyword(s):  
Cardiac Function ◽  
Coronary Atherosclerosis ◽  
Left Ventricular ◽  
Epicardial Fat ◽  
Secondary Outcome ◽  
Negatively Associated ◽  
Fat Depots ◽  
Brown Adipose ◽  
Fat Fraction ◽  
Subcutaneous Adipose

OBJECTIVES/SPECIFIC AIMS: The study aims to understand if pro inflammatory epicardial white adipose phenotype is positively associated with coronary atherosclerosis, while the brown adipose phenotype is negatively associated. Primary outcome is association between epicardial fat fraction and coronary atherosclerosis and cardiac function. Secondary outcome is transcriptomic and lipidomic profiling between epicardial, extra pericardial, and subcutaneous depots and how these profiles correlate with fat fraction. METHODS/STUDY POPULATION: Recruited patients undergoing open-heart surgery provided informed consent at their second visit and underwent laboratory testing and imaging (cardiac magnetic resonance including water-fat imaging and coronary calcium computed tomography) prior to their surgery. Cardiac function such as cardiac chamber volume, mass, function, and strain, and depo-specific fat fraction were calculated from cardiac MR and Agatston calcium score and epicardial adipose volume from CT images. At the time of surgery, a tissue specimens from the epicardial, extrapericardial, and subcutaneous depots were obtained for transcriptomic and lipidomic analysis. Linear and logistic regression analyses adjusted for other variables were performed to evaluate significance level between variables. RESULTS/ANTICIPATED RESULTS: 37 subjects were enrolled in the study, 13 (35%) of which were women. Cardiac function and fat fraction was quantified in all patients, whereas tissue analyses were performed in 22 patients. Epicardial and extrapericardial fat fraction were independently associated with coronary atherosclerosis (p-value 0.01 and 0.04 respectively) Only epicardial fat fraction was negatively associated with global circumferential shortening of the left ventricle (0.03), while neither the extrapericardial fat fraction nor epicardial adipose volume were not (p =0.33 and 0.97 respectively) All three adipose depots have unique gene signatures with differentially expressed genes and pathways. RNA sequencing of epicardial, extrapericardial, and subcutaneous depots demonstrated tight clustering of epicardial and subcutaneous signatures based on PCA analysis (Figure 2). 19 lipid classes and 59 lipids showed differential expression between at least 2 of the fat depots (Figure 3). Hierarchal clustering of the lipids showed that epicardial and extrapericardial depots were more closely related than subcutaneous adipose. Plasmenyl-phosphatidylcholines, with an ether-linked fatty acid at the sn-1 position of the lipid, were higher in subcutaneous fat while most other lipids were higher in epicardial fat per tissue weight, such as ceramides (p=0.002). DISCUSSION/SIGNIFICANCE OF IMPACT: Epicardial, extrapericardial, and subcutaneous adipose depots express different lipidome and transcriptome signatures and different pathways. GSEA analysis demonstrated enrichment of genes related to antigen presentation and B cell immunity in epicardial compared to subcutaneous adipose tissue. Epicardial fat fraction is associated with coronary atherosclerosis and decreased left ventricular global circumferential shortening as an early predictor of decreased left ventricular stroke volume. Epicardial fat fraction is also associated with cermides which may play role in the development of coronary atherosclerosis and decreased cardiac function.

scholarly journals Body composition and bone mineral density in women with Cushing's syndrome in remission and the association with common genetic variants influencing glucocorticoid sensitivity

2015 ◽  
Vol 172 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Oskar Ragnarsson ◽  
Camilla A M Glad ◽  
Ragnhildur Bergthorsdottir ◽  
Erik G Almqvist ◽  
Eva Ekerstad ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Body Composition ◽  
Bone Mineral ◽  
Fat Mass ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Abdominal Fat ◽  
Controlled Study ◽  
Mineral Density

ObjectiveAdverse body compositional features and low bone mineral density (BMD) are the characteristic of patients with active Cushing's syndrome (CS). The aim of this study was to evaluate body composition and BMD in women with CS in long-term remission and the influence of polymorphisms in genes affecting glucocorticoid (GC) sensitivity on these end-points.Design, patients and methodsThis was a cross-sectional, case–controlled study, including 50 women previously treated for CS and 50 age and gender-matched controls. Median (interquartile range) remission time was 13 (5–19) years. Body composition and BMD were measured with dual-energy X-ray absorptiometry. Five polymorphisms in four genes associated with GC sensitivity were analysed using TaqMan or Sequenom single-nucleotide polymorphism genotyping.ResultsPatients with CS in remission had increased abdominal fat mass (P<0.01), whereas BMD was not significantly different at any site between patients and controls. In patients, the NR3C1 Bcl1 polymorphism was associated with reduced total (P<0.05) and femur neck BMD (P<0.05). The polymorphism rs1045642 in the ABCB1 gene was associated with increased abdominal fat mass (P<0.05) and decreased appendicular skeletal muscle mass (P<0.05). GC replacement was associated with reduced total BMD (P<0.01), BMD at lumbar spine (P<0.05) and increased abdominal fat (P<0.01).ConclusionOngoing GC replacement therapy together with polymorphisms in two genes related with GC sensitivity is associated with abdominal obesity and adverse skeletal health in patients with CS in long-term remission.

scholarly journals Cushing’s Disease Presented by Reversible Dilated Cardiomyopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Berna İmge Aydoğan ◽  
Demet Menekşe Gerede ◽  
Asena Gökçay Canpolat ◽  
Murat Faik Erdoğan
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Ventricular Hypertrophy ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Cushing's Disease ◽  
Resonance Imaging ◽  
Transsphenoidal Adenomectomy ◽  
Proximal Myopathy

Introduction. Dilated cardiomyopathy is rarely reported among CS patients especially without hypertension and left ventricular hypertrophy.Materials and Methods. We hereby report a Cushing’s syndrome case presenting with dilated cardiomyopathy.Results. A 48-year-old female patient was admitted to our clinic with severe proximal myopathy and dilated cardiomyopathy without ventricular hypertrophy. Cushing’s disease was diagnosed and magnetic-resonance imaging of the pituitary gland revealed a microadenoma. Under diuretic and ketoconazole treatments, she underwent a successful transnasal/transsphenoidal adenomectomy procedure. Full recovery of symptoms and echocardiographic features was achieved after six months of surgery.Conclusion. Cushing’s syndrome must be kept in mind as a reversible cause of dilated cardiomyopathy. Recovery of cardiomyopathy is achieved with successful surgery.

Left ventricular geometry and 24-h blood pressure profile in Cushing’s syndrome

Endocrine ◽  
2016 ◽  
Vol 55 (2) ◽  
pp. 547-554 ◽  
Author(s):  
Eleonora Avenatti ◽  
Andrea Rebellato ◽  
Andrea Iannaccone ◽  
Marialberta Battocchio ◽  
Francesca Dassie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cushing’S Syndrome ◽  
Pressure Profile ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Ventricular Geometry ◽  
Blood Pressure Profile

scholarly journals Cardiac dysfunction is reversed upon successful treatment of Cushing's syndrome

2010 ◽  
Vol 162 (2) ◽  
pp. 331-340 ◽  
Author(s):  
Alberto M Pereira ◽  
Victoria Delgado ◽  
Johannes A Romijn ◽  
Johannes W A Smit ◽  
Jeroen J Bax ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Successful Treatment ◽  
Strain Imaging ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Cardiac Structure ◽  
Two Dimensional ◽  
Functional Changes ◽  
Number Of Patients ◽  
Prospective Study Design

ObjectiveIn patients with active Cushing's syndrome (CS), cardiac structural and functional changes have been described in a limited number of patients. It is unknown whether these changes reverse after successful treatment. We therefore evaluated the changes in cardiac structure and dysfunction after successful treatment of CS, using more sensitive echocardiographic parameters (based on two-dimensional strain imaging) to detect subtle changes in cardiac structure and function.MethodsIn a prospective study design, we studied 15 consecutive CS patients and 30 controls (matched for age, sex, body surface area, hypertension, and left ventricular (LV) systolic function). Multidirectional LV strain was evaluated by two-dimensional speckle tracking strain imaging. Systolic (radial thickening, and circumferential and longitudinal shortening) and diastolic (longitudinal strain rate at the isovolumetric relaxation time (SRIVRT)) parameters were measured.ResultsAt baseline, CS patients had similar LV diameters but had significantly more LV hypertrophy and impaired LV diastolic function, compared to controls. In addition, CS patients showed impaired LV shortening in the circumferential (−16.5±3.5 vs −19.7±3.4%, P=0.013) and longitudinal (−15.9±1.9 vs −20.1±2.3%, P<0.001) directions and decreased SRIVRT (0.3±0.15 vs 0.4±0.2/ s, P=0.012) compared to controls. After normalization of corticosteroid excess, LV structural abnormalities reversed, LV circumferential and longitudinal shortening occurred, and SRIVRT normalized.ConclusionCS induces not only LV hypertrophy and diastolic dysfunction but also subclinical LV systolic dysfunction, which reverses upon normalization of corticosteroid excess.

scholarly journals Left ventricular structural and functional characteristics in Cushing’s syndrome

2003 ◽  
Vol 41 (12) ◽  
pp. 2275-2279 ◽  
Author(s):  
Maria Lorenza Muiesan ◽  
Mario Lupia ◽  
Massimo Salvetti ◽  
Consuelo Grigoletto ◽  
Nicoletta Sonino ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Functional Characteristics

scholarly journals Increased myocardial fibrosis and left ventricular dysfunction in Cushing's syndrome

2012 ◽  
Vol 166 (1) ◽  
pp. 27-34 ◽  
Author(s):  
Kai Hang Yiu ◽  
Nina Ajmone Marsan ◽  
Victoria Delgado ◽  
Nienke R Biermasz ◽  
Eduard R Holman ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diastolic Function ◽  
Myocardial Fibrosis ◽  
Cushing’S Syndrome ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Cushing's Syndrome ◽  
Left Ventricular ◽  
Function Assessment

ObjectiveActive Cushing's syndrome (CS) is associated with cardiomyopathy, characterized by myocardial structural, and ultrastructural abnormalities. The extent of myocardial fibrosis in patients with CS has not been previously evaluated. Therefore, the objective of this study was to assess myocardial fibrosis in CS patients, its relationship with left ventricular (LV) hypertrophy and function, and its reversibility after surgical treatment.Design and methodsFifteen consecutive CS patients (41±12 years) were studied together with 30 hypertensive (HT) patients (matched for LV hypertrophy) and 30 healthy subjects. Echocardiography was performed in all patients including i) LV systolic function assessment by conventional measures and by speckle tracking-derived global longitudinal strain, ii) LV diastolic function assessment using E/E′, and iii) myocardial fibrosis assessment using calibrated integrated backscatter (IBS). Echocardiography was repeated after normalization of cortisol secretion (14±3 months).ResultsCS patients showed the highest value of calibrated IBS (−15.1±2.5 dB) compared with HT patients (−20.0±2.6 dB,P<0.01) and controls (−23.8±2.4 dB,P<0.01), indicating increased myocardial fibrosis independent of LV hypertrophy. Moreover, calibrated IBS in CS patients was significantly related to both diastolic function (E/E′,r=0.79,P<0.01) and systolic function (global longitudinal strain,r=0.60,P=0.02). After successful surgical treatment, calibrated IBS normalized (−21.0±3.8 vs −15.1±2.5 dB,P<0.01), suggestive of regression of myocardial fibrosis.ConclusionsPatients with CS have increased myocardial fibrosis, which is related to LV systolic and diastolic dysfunction. Successful treatment of CS normalizes the extent of myocardial fibrosis. Therefore, myocardial fibrosis appears to be an important factor in the development and potential regression of CS cardiomyopathy.

Sign in / Sign up

Export Citation Format

Share Document