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Coronary microvascular function in patients with Cushing’s syndrome

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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.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    Francesco Fallo, Dario Capizzi, Francesca Dassie, Pietro Maffei & Chiara Martini

  2. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy

    Giulia Famoso, Sabino Iliceto & Francesco Tona

  3. Department of Statistical Sciences, University of Padova, Padua, Italy

    Nicoletta Sonino

  4. Endocrine Unit, Cittadella City Hospital, Cittadella, Italy

    Agostino Paoletta

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  1. Francesco Fallo
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  2. Giulia Famoso
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Correspondence to Francesco Fallo.

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Fallo, F., Famoso, G., Capizzi, D. et al. Coronary microvascular function in patients with Cushing’s syndrome. Endocrine 43, 206–213 (2013). https://doi.org/10.1007/s12020-012-9764-2

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