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 3 – Comparison of tissue Doppler parameters and atrial conduction times between groups Variable Non-functioning AI (n = 30) Control (n = 46) p value LV lateral annulus Sm b (cm/s) Median (Q1-Q3) 9(8,00–11,00) 10(8,00–11,00) 0.39 Em/Am b Median (Q1-Q3) 0,72(0,62–1,00) 0,93(0,79–1,20) 0.02* E/Em b Median (Q1-Q3) 6,77(5,29–8,33) 6,82(5,50–7,46) 0.52 MPI b Median (Q1-Q3) 0,44(0,39–0,53) 0,46(0,42–,52) 0.81 LV septal annulus Sm a (cm/s) 8.80 ± 2.11 8.37 ± 1.43 0.43 Em/Am b Median (Q1-Q3) 0,64(0,55–0,83) 0,73(0,63–1,00) 0.03* E/Em a 10.16 ± 3.36 10.18 ± 2.22 0.77 MPI a 0.52 ± 0.07 0.47 ± 0.11 0.004* RV tricuspid annulus Sm a (cm/s) 15.57 ± 3.57 14.35 ± 2.77 0.11 Em/Am b Median (Q1-Q3) 0,58(0,46–0,67) 0,67(0,60–0,81) 0.004* MPI a 0.46 ± 0.06 0.43 ± 0.10 0.11 LV Sm b (cm/s) Median (Q1-Q3) 9,00(7,50–10,00) 9,00(8,00–10,50) 0.96 LV Em/Am a 0.76 ± 0.24 0.88 ± 0.22 0.01* LV E/Em b Median (Q1-Q3) 7,85(6,25–10,00) 8,15(6,79–9,29) 0.90 LV MPI a 0.50 ± 0.05 0.47 ± 0.12 0.03* Atrial conduction times Lateral PA a (ms) 45.97 ± 10.95 42.35 ± 8.16 0.09 Septum PA a (ms) 30.87 ± 9.86 31.11 ± 7.21 0.78 Tricuspid PA b (ms) Median (Q1-Q3) 21,00(18,00–26,00) 22,00(18,00–26,00) 0.34 Intra-atrial EMD a (ms) 15.10 ± 7.97 11.24 ± 4.08 0.016* Inter-atrial EMD a (ms) 23.53 ± 7.99 18.85 ± 5.79 0.008* a Independent samples t test; b Mann-Whitney U test; Median (Q1-Q3): Median (1.Quartile-3Quartile); *difference is statistically significant; AI: adrenal incidentaloma; LV: left ventricular; MPI: myocardial performance index; RV: right ventricular; PA: time interval from the onset of P wave on electrocardiogram (ECG) to the beginning of the A wave; EMD: electromechanical delay. Table 4 – Assessment of subtle cortisol secretion related effects on intra-atrial electromechanical delay (EMD) Hypothesis Test Parameter B Standard Error Wald Chi-square p Intercept 13.121 4,0795 10.345 0.001 Post DST cortisol 4.752 2.4347 3.810 0.049* Cortisol -0.265 0.2642 1.004 0.316 ACTH -0.090 0.0725 1.551 0.213 DHEAS 0.008 0.0167 0.258 0.611 Generalized Linear Models; α: 0,05; *effect is statistically significant; DST: dexamathasone supression test; ACTH: adrenocorticotrophic hormone; DHEAS: dedhydroepiandrostenedione sulphate. degree of autonomous adrenal function. In this study, we obtained some indirect evidence of subtle cortisol autonomy and cardiovascular risk in patients with nonfunctioning AI. There are few studies analyzing cardiac morphology and function in nonfunctional AI. Ermetici et al. 12 reported the presence of LV hypertrophy and LV diastolic dysfunction in patients with nonfunctional AI. 12 Iacobellis et al. 5 showed increased epicardial fat thickness and LV mass by transthoracic echocardiography in these subjects. 5 Similarly, we found that LV mass index was increased significantly in patients with nonfunctional AI compared to the control group. The impact of LV hypertrophy on cardiac mortality and morbidity has been understood increasingly. 16 It has been suggested that cortisol production by AI may have a broad spectrum, ranging 660