Faculté de Médecine (P.K., S.S., S.B., J.Y., P.C.), Univ Paris-Sud, F-94276 Le Kremlin Bicêtre, France; Faculté de Médecine (A.R., N.K.), Sorbonne Universités, Université Pierre et Marie Curie Univ Paris 06, F75006 Paris, France; Faculté de Médecine (E.M.), Université Paris Descartes, F75006 Paris, France; Service d'Endocrinologie et des Maladies de la Reproduction (P.K., S.S., J.Y., P.C.) and Service de Pharmacogénétique (S.B.), Biochimie Moléculaire et Hormonologie, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, F-94275 Le Kremlin Bicêtre, France; Département d'Imagerie Cardiovasculaire (A.R.) and Service d'Endocrinologie (C.J.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, F75013 Paris, France; Service de Radiologie Cardiovasculaire (C.R., L.M., A.A., Z.R., E.M.), Hôpital Européen George Pompidou, Assistance Publique-Hôpitaux de Paris, F75015 Paris, France; Service d'Endocrinologie (L.G.), Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, F75006 Paris, France; U693 (P.K., J.Y., S.B., P.C.), Institut National de la Santé et de la Recherche Médicale (INSERM), F-94276 Le Kremlin Bicêtre, France; Unité Mixte de Recherche 7371 and Unité Mixte de Recherche en Santé 1146 (A.R., N.K.), Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, INSERM, F-75013 Paris, France.
J Clin Endocrinol Metab. 2014 Nov;99(11):E2144-53. doi: 10.1210/jc.2014-1783. Epub 2014 Aug 5.
Patients with Cushing's syndrome have left ventricular (LV) hypertrophy and dysfunction on echocardiography, but echo-based measurements may have limited accuracy in obese patients. No data are available on right ventricular (RV) and left atrial (LA) size and function in these patients.
The objective of the study was to evaluate LV, RV, and LA structure and function in patients with Cushing's syndrome by means of cardiac magnetic resonance, currently the reference modality in assessment of cardiac geometry and function.
Eighteen patients with active Cushing's syndrome and 18 volunteers matched for age, sex, and body mass index were studied by cardiac magnetic resonance. The imaging was repeated in the patients 6 months (range 2-12 mo) after the treatment of hypercortisolism.
Compared with controls, patients with Cushing's syndrome had lower LV, RV, and LA ejection fractions (P < .001 for all) and increased end-diastolic LV segmental thickness (P < .001). Treatment of hypercortisolism was associated with an improvement in ventricular and atrial systolic performance, as reflected by a 15% increase in the LV ejection fraction (P = .029), a 45% increase in the LA ejection fraction (P < .001), and an 11% increase in the RV ejection fraction (P = NS). After treatment, the LV mass index and end-diastolic LV mass to volume ratio decreased by 17% (P < .001) and 10% (P = .002), respectively. None of the patients had late gadolinium myocardial enhancement.
Cushing's syndrome is associated with subclinical biventricular and LA systolic dysfunctions that are reversible after treatment. Despite skeletal muscle atrophy, Cushing's syndrome patients have an increased LV mass, reversible upon correction of hypercortisolism.
患有库欣综合征的患者在超声心动图上存在左心室（LV）肥厚和功能障碍，但基于回声的测量在肥胖患者中可能准确性有限。目前尚缺乏这些患者右心室（RV）和左心房（LA）大小和功能的数据。
本研究旨在通过心脏磁共振评估库欣综合征患者的 LV、RV 和 LA 结构和功能，心脏磁共振是评估心脏几何形状和功能的参考模式。
对 18 例活动性库欣综合征患者和 18 名年龄、性别和体重指数匹配的志愿者进行心脏磁共振检查。在皮质醇增多症治疗后 6 个月（2-12 个月）重复进行影像学检查。
与对照组相比，库欣综合征患者的 LV、RV 和 LA 射血分数较低（均 P <.001），LV 舒张末期节段厚度增加（P <.001）。皮质醇增多症的治疗与心室和心房收缩功能的改善相关，LV 射血分数增加 15%（P =.029），LA 射血分数增加 45%（P <.001），RV 射血分数增加 11%（P = NS）。治疗后，LV 质量指数和 LV 舒张末期质量与容积比分别降低 17%（P <.001）和 10%（P =.002）。没有患者出现延迟钆增强心肌强化。
库欣综合征与亚临床双心室和 LA 收缩功能障碍有关，这些功能障碍在治疗后是可逆的。尽管存在骨骼肌萎缩，但库欣综合征患者的 LV 质量增加，在皮质醇增多症纠正后可恢复正常。
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