Left Ventricular Diastolic Function Assessment by Tissue Doppler Echocardiography in Relation to Hormonal Replacement Therapy in Postmenopausal Women With Diastolic Dysfunction

Abstract

The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.

Comparison of the effects of new and conventional hormone replacement therapies on left ventricular diastolic function in healthy postmenopausal women: a Doppler and ultrasonic backscatter study

“…However, this study is a crosssectional study and therefore does not address the changes in diastolic function parameters before and after HRT. Gökçe et al [15] evaluated LV diastolic function in 78 normotensive healthy postmenopausal women with diastolic dysfunction. In this study, among the conventional Doppler parameters, peak A velocity, DT, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment.…”

Estrogen and calcium handling proteins: new discoveries and mechanisms in cardiovascular diseases

“…Moreover, it was found that estrogen supplementation prevented intracellular Ca 2ϩ cycle imbalance (15) and enhanced left ventricular diastolic function in OVX monkeys (77). Previous research also illustrated that estrogen supplementation improved the diastolic function of women with LVDD and animal models of LVDD (39,63,130). Taken together, estrogen balances the Ca 2ϩ homeostasis cycle and improves myocardial diastolic function, thereby reducing the incidence of DDrelated cardiovascular disease in postmenopausal women.…”

Female Heart Health: Is GPER the Missing Link?

“…Moreover, when older women are compared with their agematched male counterparts, the likelihood of manifesting more prominent diastolic dysfunction is increased (32)(33)(34). Findings from small clinical (35)(36)(37)(38)(39) and animal studies, as reviewed by us (40) and others (31,41), document estrogen therapy efficacy in improving diastolic function and/or limiting increases in LV mass and interstitial remodeling after surgically induced or natural menopause. These data affirm estrogen's role in the preservation of diastolic function in the female heart.…”