The patient's sex determines the hemodynamic profile in patients with Cushing disease

Agnieszka Jurek; Paweł Krzesiński; Beata Uziębło-Życzkowska; Przemysław Witek; Grzegorz Zieliński; Anna Kazimierczak; Robert Wierzbowski; Małgorzata Banak; Grzegorz Gielerak

doi:10.3389/fendo.2023.1270455

The patient's sex determines the hemodynamic profile in patients with Cushing disease

Front Endocrinol (Lausanne). 2023 Oct 11:14:1270455. doi: 10.3389/fendo.2023.1270455. eCollection 2023.

Authors

Agnieszka Jurek¹, Paweł Krzesiński¹, Beata Uziębło-Życzkowska¹, Przemysław Witek², Grzegorz Zieliński³, Anna Kazimierczak¹, Robert Wierzbowski¹, Małgorzata Banak¹, Grzegorz Gielerak¹

Affiliations

¹ Department of Cardiology and Internal Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland.
² Department of Internal Medicine, Endocrinology, and Diabetes, Medical University of Warsaw, Warsaw, Poland.
³ Department of Neurosurgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland.

Abstract

Background: Cushing disease (CD) may lead to accelerated cardiovascular remodeling and increased mortality. There are suspected differences in the mechanism of cardiovascular dysfunction between males and females with CD. The purpose of this study was to assess the effect of patient sex on the hemodynamic profile assessed via impedance cardiography and echocardiography in patients newly diagnosed with CD.

Material and methods: The 54 patients newly diagnosed with CD (mean age 41 years; 77.8% of females) who were included in this prospective clinical study underwent impedance cardiography to assess specific parameters (including systemic vascular resistance index [SVRI], total arterial compliance index [TACI], Heather index [HI], stroke index [SI], cardiac index [CI], velocity index [VI], and acceleration index [ACI]) and transthoracic echocardiography to assess heart chamber diameters and left ventricular systolic and diastolic function.

Results: Males with CD exhibited higher afterload, with higher SVRI (3,169.3 ± 731.8 vs. 2,339.3 ± 640.8 dyn*s*cm^-5*m² in males and females, respectively; p=0.002), lower TACI (0.80 ± 0.30 vs. 1.09 ± 0.30 mL/mmHg*m²; p=0.008), and lower hemodynamic parameters of left ventricular function, with lower HI (9.46 ± 2.86 vs. 14.1 ± 5.06 Ohm/s²; p=0.0007), lower VI (35.1 ± 11.9 vs. 44.9 ± 13.1 1*1000^-1*s^-1; p=0.009), lower SI (36.5 ± 11.7 vs. 43.6 ± 9.57 mL/m²; p=0.04), lower CI (2.36 ± 0.46 vs. 3.17 ± 0.76 mL*m^-2*min^-1; p=0.0009), and lower ACI (50.4 ± 19.8 vs. 73.6 ± 25.0 1/100/s²; p=0.006). There were no significant differences between the sexes in left ventricular systolic or diastolic function assessed by echocardiography.

Conclusion: In comparison with females with CD, males with CD have a less favorable hemodynamic profile, with higher afterload and worse left ventricular function. Sex differences in cardiovascular system function should be taken into consideration in designing personalized diagnostic and therapeutic management of patients with CD.

Keywords: Cushing disease; cardiovascular complications; echocardiography; hemodynamic profile; impedance cardiography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Echocardiography
Female
Heart
Hemodynamics
Humans
Male
Pituitary ACTH Hypersecretion*
Prospective Studies

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Ministry of Science and Higher Education/Military Institute of Medicine -National Research Institute in Warsaw, Poland (grant No. 453/WIM).