Abstract Objectives This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing’s syndrome. Background A high prevalence of LV hypertrophy and concentric remodeling has been reported in Cushing’s syndrome, although no data have been reported on LV systolic and diastolic function. Methods Forty-two consecutive patients with Cushing’s syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow. Results The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing’s syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 ± 3% vs. 21 ± 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p < 0.001, respectively). Conclusions In patients with Cushing’s syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.