ABC | Volume 111, Nº5, November 2018

Original Article Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma Gulizar Sokmen, 1 Murat Sahin, 1 Dilek Tuzun, 1 Abdullah Sokmen, 1 Hanife Bolat, 2 Ayten Oguz, 3 Adem Doganer, 4 Huseyin Nacar, 1 Kamile Gul 3 Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Cardiology, 1 Kahramanmaraş – Turkey Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Internal Medicine, 2 Kahramanmaraş – Turkey Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Endocrinology, 3 Kahramanmaraş – Turkey Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, 4 Kahramanmaraş – Turkey Mailing Address: Gulizar Sokmen • Kahramanmaras Sutcu Imam Universitesi, Tip Fakultesi, Kardiyoloji AD. 46000, Kahramanmaras – Turkey E-mail: guliz58@yahoo.com Manuscript received November 24, 2017, revised manuscript May 10, 2018, accepted May 10, 2018 DOI: 10.5935/abc.20180188 Abstract Background: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. Objective: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Methods: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. Results: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. Conclusion: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk. (Arq Bras Cardiol. 2018; 111(5):656-663) Keywords: Incidental Findings; Diastole/function; Adrenocortical Adenoma; Diagnostic ,Imaging; Metabolic Syndrome; Cardiac Conduction System Disease Introduction Adrenal incidentaloma (AI) is defined as an adrenal mass, generally discovered in radiological interventions for indications other than adrenal disease. The classic definition excludes patients with clinically overt adrenal hormone secretion, and those with concurrent malignancy, known as metastasis to the adrenals . The prevalence of adrenal masses in general population has been reported to be as high as 6% at autopsy, and 2.5–4.2% on evaluation of abdomen and thorax by computerized tomography (CT). 1 Majority of the incidentally discovered adrenal masses are nonfunctioning adrenal adenomas. 2 The appropriate management of these patients is still a matter of debate, and it is necessary to investigate their associated morbidity. The presence of AI has been proposed as a new cause of metabolic syndrome and reported to increase cardiovascular disease risk. The burden of disturbances showed diversity from impaired glucose tolerance to increased epicardial fat thickness and intima‑media thickness of common carotid arteries. 2-6 However, data regarding morphological and functional cardiac alterations are still limited in this particular group. Atrial fibrillation (AF) is one of themost common arrhythmias observed in clinical practice. Several electrocardiographic and echocardiographic markers reflecting electrophysiological and electromechanical abnormalities of atria prone to develop AF have been studied with the aim of early identification of patients susceptible to develop AF. Atrial electromechanical delay (EMD) has been defined as the temporal delay between 656