# Global Longitudinal Strain Reduction With Apical Sparing in Cushing Syndrome-Related Heart Failure With Preserved Ejection Fraction (HFpEF): A Case Report

## TL;DR

A 56-year-old woman with Cushing syndrome showed heart failure symptoms with preserved ejection fraction, highlighting the link between chronic hypercortisolism and heart issues.

## Contribution

This case report demonstrates that chronic hypercortisolism can lead to heart failure with preserved ejection fraction.

## Key findings

- Chronic hypercortisolism may cause myocardial fibrosis and impaired mechanics resembling infiltrative cardiomyopathy.
- HFpEF can occur in Cushing syndrome without amyloidosis.
- Recognizing this overlap is essential to avoid misdiagnosis and ensure proper treatment.

## Abstract

We describe a case of a 56-year-old woman with a history of recurrent pituitary adenoma, not well followed, and known comorbidities of coronary artery disease, hypertension, and type 2 diabetes mellitus. She arrived with severely high blood pressure and signs pointing to hypercortisolism. Further evaluation revealed left ventricular hypertrophy, reduced global longitudinal strain, and preserved left ventricular ejection fraction, consistent with heart failure with preserved ejection fraction (HFpEF). Workup for amyloidosis was negative. This case highlights that chronic hypercortisolism may cause pathophysiological changes in the heart, leading to HFpEF, and may induce myocardial fibrosis and impaired myocardial mechanics, producing an echocardiographic pattern that can mimic infiltrative cardiomyopathy. Recognition of this overlap is crucial to avoid misdiagnosis and to ensure timely endocrine and cardiovascular management.