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The following is a summary of “Impact Of Hypercortisolism Beyond Metabolic Syndrome On Left Ventricular Performance: A Myocardial Work Analysis,” published in the March 2025 issue of Cardiovascular Diabetology by Sahiti et al.

Endogenous Cushing’s Syndrome (CS) is associated with an increased cardiovascular (CV) and metabolic risk profile, yet the specific impact of hypercortisolism on myocardial function remains inadequately understood. Myocardial Work analysis, a novel echocardiographic technique utilizing left ventricular pressure-strain loops, allows for the assessment of cardiac performance independently of afterload, offering valuable insight into myocardial function in CS. This cross-sectional study aimed to evaluate left ventricular function across four distinct groups: patients with overt endogenous CS (n = 31; mean age 47 ± 12 years; 71% women), patients in long-term remission following successful medical treatment (CS-LTR; n = 49; mean age 53 ± 12 years; 78% women), a healthy control group (n = 439; mean age 49 ± 11 years; 57% women), and individuals with metabolic syndrome (n = 305; mean age 59 ± 10 years; 37% women). 

Both CS groups exhibited a more unfavorable metabolic and CV risk profile than healthy controls, although they presented a relatively better profile compared to individuals with metabolic syndrome. Adjusted analyses accounting for sex and age demonstrated significantly increased Wasted Work in both the overt CS group (median: 105 mmHg%; interquartile range: 74–147) and CS-LTR group (97 mmHg%; 69–158) when compared to healthy individuals (75 mmHg%; 54–109; p < 0.01). Additionally, wasted work values in patients with CS were slightly elevated in comparison to those observed in patients with metabolic syndrome (95 mmHg%; 65–136; p < 0.05), indicating persistent myocardial dysfunction. This impairment in myocardial performance translated into a significant reduction in Work Efficiency (p < 0.05), even in patients with CS who had achieved biochemical remission. 

The findings suggest that hypercortisolism contributes to persistent left ventricular dysfunction beyond the effects of traditional CV risk factors. Furthermore, despite the biochemical resolution of CS, patients in long-term remission continue to exhibit myocardial abnormalities, reinforcing the notion that prior exposure to excess cortisol may induce lasting structural and functional cardiac alterations. These findings underscore the utility of Myocardial Work analysis in detecting subclinical yet clinically relevant myocardial dysfunction in patients with CS, both in its active state and after remission. Given the persistence of myocardial impairment even following the resolution of hypercortisolism, long-term cardiovascular monitoring may be warranted in this patient population. This study highlights the need for further research to determine whether targeted interventions could mitigate residual myocardial dysfunction in patients with a history of CS, ultimately improving their cardiovascular outcomes.

Source: cardiab.biomedcentral.com/articles/10.1186/s12933-025-02680-1