ABC | Volume 111, Nº5, November 2018

Original Article Sokmen te al Cardiac functions in adrenal incidentaloma Arq Bras Cardiol. 2018; 111(5):656-663 Table 2 – Comparison of conventional echocardiographic parameters between groups Variable Non-functioning AI (n = 30) Control (n = 46) p value LV end-diastolic diameter a (mm) 48.83 ± 3.70 46.93 ± 3.64 0.07 LV end-systolic diameter b (mm) Median (Q1-Q3) 27(26,00–28,00) 27(25,00–30,00) 0.96 LV ejection fraction a (%) 71.93 ± 7.54 72.26 ± 5.84 0.68 IVS diastolic thickness b (mm) Median (Q1-Q3) 10(9,00–11,00) 9(8,00–11,00) 0.03* PW diastolic thickness b (mm) Median(Q1-Q3) 11(9,00–12,00) 10(9,00–11,00) 0.03* LV mass index a (gr/m 2 ) 112.01 ± 26.93 95.33 ± 21.69 0.004* Left atrial diameter a (mm) 36.27 ± 2.79 35.59 ± 2.84 0.31 Mitral E/A ratio a 0.87 ± 0.25 1.01 ± 0.30 0.07 RV basal diameter a (mm) 32.14 ± 3.54 32.74 ± 3.91 0.51 RA diameter a (mm) 32.20 ± 4.71 32.61 ± 3.98 0.69 TAPSE b (mm) Median (Q1-Q3) 24(20,00–26,00) 22,50(21,00–27,00) 0.42 sPAP a (mmHg) 25.67 ± 3.45 26.11 ± 3.92 0.65 PAT a (ms) 96.38 ± 22.08 113.48 ± 26.36 0.004* a Independent samples t test; b Mann-Whitney U test; Median (Q1-Q3): Median (1.Quartile-3.Quartile); *difference is statistically significant; AI: adrenal incidentaloma; LV: left ventricular; IVS: interventricular septum; PW: posterior wall; RV: right ventricular; RA: right atrial; TAPSE: tricuspid annular plane systolic excursion; sPAP: systolic pulmonary artery pressure; PAT: pulmonary acceleration time. levels were significantly lower in nonfunctioning AI group (p = 0.009 and p < 0.001, respectively). Cortisol levels were similar, but suppression with 1 mg DST was pronounced significantly in the control group (p < 0.001). Other laboratory data including fasting plasma glucose, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride and insulin levels did not differ between groups. Conventional echocardiographic parameters were shown in Table 2. There were no significant differences between groups considering LV end-diastolic and end-systolic diameters, LV ejection fraction, diameter of left and right atrium, RV diameter, TAPSE and systolic PAP. Diastolic thickness of interventricular septum (IVS), posterior wall (PW) and LV mass index was significantly higher (p = 0.03, p = 0.03, and p = 0.004 respectively), and PAT was significantly lower (p = 0.004) in nonfunctioning AI group. Although mitral E/A ratio was lower in nonfunctioning AI compared to the control group, the difference was not statistically significant (p = 0.07). Comparison of tissue Doppler parameters and atrial conduction times were demonstrated in Table 3. LV lateral, LV septal, global LV Em/Am and RV Em/Am were decreased significantly in nonfunctioning AI group (p = 0.02, p = 0.03, p = 0.01, and p = 0.004, respectively). LV septal MPI and LV MPI were significantly higher in nonfunctioning AI group (p = 0.004 and p = 0.03, respectively), whereas LV lateral and RV MPI did not differ significantly between groups. There was no significant difference between groups with regard to Sm and E/Em. PA lateral, PA septum and PA tricuspid were not different between groups. Inter-atrial EMD and intra-atrial EMD were significantly higher in nonfunctioning AI group compared to the controls (p = 0.008 and p = 0.016, respectively). Bivariate correlation analysis revealed that inter-atrial EMD was negatively correlated with ACTH level (r = -0.29, p = 0.027), mitral E/A ratio (r = -0.33, p = 0.004), and RV Em/Am ratio (r = -0.29, p = 0.011), and positively correlated with LV mass index (r = 0.38, p = 0.001), left atrial diameter (r = 0.23, p = 0.04), age (r = 0.32, p = 0.004) and systolic blood pressure (r = 0.23, p = 0.04). Intra‑atrial EMD was positively correlated with post DST cortisol level (r = 0.23, p = 0.04), LV mass index (r = 0.33, p = 0.004), age (r = 0.34, p = 0.003) and systolic blood pressure (r = 0.32, p = 0.004), and negatively correlated with mitral E/A ratio (r = -0.36, p = 0.002). Multivariate relationships of inter‑ and intra-atrial EMD with clinical parameters revealed that changes in post DST cortisol levels affected intra-atrial EMD significantly (Wald χ 2  = 3.810, p = 0.049) (Table 4). We also found that increase of post DST cortisol level by 1 µg/dl lengthened intra-atrial EMD by 4.752 msec. Discussion This is the first tissue Doppler echocardiographic study evaluating abnormalities of atrial conduction together with cardiac structure and function in nonfunctional adrenal incidentalomas. We obtained two important findings: • LV mass increased significantly; • Intra- and inter-atrial conduction times were delayed significantly in these patients. It is well known that overt cortisol excess, as in Cushing syndrome, may lead to systemic complications responsible for increased cardiovascular risk (hypertension, obesity, impaired glucose metabolism, dyslipidemia) and cardiovascular complications such as coronary heart disease and congestive heart failure. 6,19 It has also been shown previously that Cushing syndrome causes cardiac structural changes associated with LV dysfunction. 20,21 However, it is still a matter of debate whether nonfunctional AI increases the risk of cardiovascular disease and whether this type of adrenal tumor has some 659