Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma

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.

摘要 背景：绝大多数偶然发现的肾上腺肿物被称为肾上腺偶发瘤（adrenal incidentaloma, AI），均为无功能性肾上腺腺瘤。目前针对肾上腺偶发瘤的合理管理仍存在争议，因此有必要探究其相关并发症发病情况。然而，该人群中心脏形态与功能改变的相关数据仍较为有限。 目的：本研究旨在评估无功能性肾上腺偶发瘤患者的心脏结构与功能特征，以及心房传导特性。 方法：本研究共纳入30名无功能性肾上腺偶发瘤患者，以及46名匹配良好的对照受试者。所有参与者在完成激素与生化分析后，均接受经胸超声心动图检查，以获取双心室的收缩与舒张参数，同时通过组织多普勒超声心动图测量心房传导时间。数据采用Windows版社会科学统计软件包（Statistical Package for the Social Sciences, SPSS，美国伊利诺伊州芝加哥市）17.0版本进行分析，以P<0.05作为具有统计学显著性的判定标准。 结果：肾上腺偶发瘤组的左心室（left ventricular, LV）质量指数及左心室心肌性能指数显著升高。在心房传导时间指标中，无功能性肾上腺偶发瘤患者的心房内及心房间电机械延迟均显著延长。其余实验室及超声心动图检查结果在两组间无显著差异。 结论：本研究发现，无功能性肾上腺偶发瘤患者的心房内及心房间传导时间延长，且左心室质量指数升高。上述发现或可作为亚临床心脏受累及心血管并发症倾向的标志物。因此，对于无功能性肾上腺偶发瘤患者，需密切随访以监测其升高的心血管风险。