Effect of estrogen replacement therapy on cardiac function in postmenopausal women with and without flushes

Abstract

Left ventricular heart function and its response to long-term estrogen replacement therapy was assessed in 30 postmenopausal women, 20 of whom had modest to severe hot flushes and 10 of whom had never had them. Continuous transdermal estradiol was given to women who had surgically induced menopause, and a combination of transdermal estradiol and sequential medroxyprogesterone acetate was given to those who had spontaneous menopause. Left ventricular systolic and diastolic function was evaluated by complete two-dimensional M-mode and pulsed Doppler echocardiography before and after 6 and 12 months of therapy. The parameters assessed were: systolic and diastolic blood pressure, heart rate, cardiac septal and posterior wall dimensions, left ventricular end-systolic and end-diastolic dimensions and volumes, ejection fraction (EF), ejection time, peak left ventricular outflow velocity (PFV), flow velocity integral (FVI), acceleration time (AT), mean acceleration of systolic flow (MA), duration of early and late filling phase, peak velocity of the early (E) and late (A) mitral flow, and A/E velocity ratio. Although no difference in chamber and wall dimensions between flushers and non-flushers was found, women with hot flushes had lower (not significantly) EF, PFV, FVI, MA, blood pressure and heart rate before therapy. Twelve-month estrogen replacement therapy significantly reduced cardiac wall dimensions and improved systolic function in both flushers and non-flushers. However, stroke volume, EF and MA were increased whereas systolic blood pressure and heart rate were decreased more in flushers. Also, the increase in E mitral flow and decrease in A/E were more pronounced in flushers. Thus, although estrogen replacement therapy significantly improves heart function in healthy postmenopausal women, there appears to be some minor differences in response between flushers and non-flushers.

The Short-Term Effects of Different Regimens of Hormone Replacement Therapy on Left Ventricular Structure and Performance in Healthy Postmenopausal Women

“…Pines et al [43] showed that postmenopausal women had an increased left ventricular wall thickness without an increase in LVM. In the current study, short-term oral and transdermal HRT and tibolone treatment failed to affect cardiac structure including left ventricular wall thickness and mass, which was consistent with some previous studies [11,14,44]. These outcomes might have been dependent on using short-term HRT.…”

“…However, the ejection fraction, which cannot be clarified by the elevated blood and plasma volume, is the important factor of the systolic cardiac function. The significant increase in ejection fraction found in each study group without any changes in heart rate was consistent with some previous studies' results [11,31] and suggests that systolic function may improve with different combined HRT regimens and tibolone. Estrogen, which can control the remodeling of the extracellular medium and change the microenvironment of cardiac cells by its effects on cardiac fibroblasts [4], may also have protective effects on cardiac myocytes independent of the coronary vasculature [32] and furthermore may have a favorable role in contraction of cardiac muscle.…”

“…Although some studies reported that estrogen replacement therapy improved systolic and diastolic functions [11][12][13][14], the outcomes of some other investigations conflicted with them [15,16]. There is a shortness of net judgment concerning whether hormone replacement therapy (HRT) can be used in postmenopausal women for the purpose of cardiovascular protection.…”

Cardiovascular consequences of hormone therapy in postmenopausal women: Messages to clinicians

“…Although it has been shown that there are differential vascular responses in flushers and non-flushers, only few studies have investigated in which way absence or presence of menopausal symptoms influences treatment effects. 23 Studies indicate that women with vasomotor symptoms have a higher basal forearm vascular flow and greater dilation responsiveness to vasoactive amines, norepinephrine and epinephrine. Therefore, these results support the possibility that there are biologic differences between symptomatic and asymptomatic women that might also affect the individual benefit-risk profile for HT.…”

Detection and Analysis of Heart Rate Variability in Young and Postmenopausal women in Different Postures

“…Farag et al [6], Rosano et al [7] and Rosa Brito-Zurita et al [8] investigated the effect of estrogen therapy on the autonomic modulation of heart rate. Tuomikoski et al [9], Beljic et al [10], Huatamaki et al [11] and Lee et al [12] evaluated the effect of hot flushes in the cardiac functioning of postmenopausal women. Brockbank et al [13] reported decreased linear HRV parameters in the postmenopausal women rather than premenopausal women.…”