Human Reproduction, Vol. 14, No. 9, 2418-2419,
September 1999
© 1999 European Society of Human Reproduction and Embryology
Letters to the Editor |
Hormone replacement therapy and cardiovascular function
Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, 52621 Tel-Hashomer, Israel
Dear Sir,
Taskin et al. (1998) summarized their findings and conclusions on the behaviour of some left ventricular systolic and diastolic echocardiographic variables in healthy post-menopausal women following 6 months of hormone replacement therapy. They found a decrease in systolic and diastolic volumes and in Doppler deceleration time, accompanied by an increase in ejection fraction and E/A velocity ratio. We would like to bring three issues to the authors' attention.
Firstly, only supposedly healthy post-menopausal women were included in the study. However the pre-treatment ejection fraction values (45.1 ± 6.2%) are low, and consequently may reflect the presence mild left ventricular dysfunction—perhaps as a result of silent ischemic heart disease—in some patients. In this case, hormone replacement therapy should not be implemented, based on the finding of no overall cardiovascular benefit (Hulley et al., 1998
).
Secondly, the data presented in Table II cause some concern. The classical methods for ejection fraction (EF) calculation based in echocardiographic end-diastolic volume (EDV) and end-systolic volume (ESV) measurements is EF = (EDV – ESV)/EDV. Employing this formula on the basis of EDV and ESV values given by authors, pre- and post-treatment ejection fractions of 50.6 and 49.6% respectively, are obtained. This is in contradiction to the reported values of 45.1 and 54.8%. Thus, a mild decrease in ejection fraction was documented following hormonal treatment and not an increase.
In the Materials and methods section, isovolumetric relaxation time is mentioned as one of the parameters examined to monitor cardiac function. Unfortunately, information on baseline values or on eventual hormone-induced changes in this parameter does not appear either in the Results section or in the Discussion. In fact, this parameter is not addressed at all.
In contrast to the well established acute effects of oestrogens on the cardiovascular system, the issue of haemodynamic changes during chronic oestrogen therapy is as yet controversial. Data from our laboratory demonstrated an increase in both stroke volume and aortic flow acceleration (Pines et al., 1991) an enhanced inotropism (Pines et al., 1992) following hormone replacement therapy. In another study, we found 6–9 months of treatment, a decrease in both left ventricular volumes and mass with improvement in Doppler systolic indices in post-menopausal hormone users with mild systemic hypertension (Pines et al., 1996a). However, such favourable findings were not corroborated when a transdermal route of administration was employed, both in short (Pines et al., 1996b) or long term trials (Pines et al., 1995).
The contradictory data in the literature could be the result of the differences in routes of administration, dosages, periods of hormone use, types of oestrogen given, serum oestrogen concentrations achieved and implementation of opposed or unopposed hormonal regimens. In this context, elucidation of the issues that we arise could contribute to clarify the uncertainties.
Notes
1 To whom correspondence should be addresssed 
References
Hulley, S., Grady, D., Bush, T. et al. (1998) Randomised trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. J. Am. Med. Assoc., 280, 605–613.
Pines, A., Fisman, E.Z., Levo, Y. et al. (1991) Long-term effects of hormone replacement therapy in normal postmenopausal women: measurements of Doppler-derived parameters of aortic flow. Am. J. Obstet, Gynecol., 164, 806–812.[Web of Science][Medline]
Pines, A., Fisman, E.Z., Ayalon, D. et al. (1992) Long-term effects of hormone replacement therapy in Doppler-derived parameters of aortic flow in postmenopausal women. Chest, 102, 1496–1498.
Pines, A., Fisman, E.Z., Averbuch, M. et al., (1995). Long-term effects of transdermal estradiol on left ventricular function and dimensions. Eur. Menopause J., 2, 22–25.
Pines, A., Fisman, E.Z., Shapira, I. et al. (1996a). Exercise echocardiography in postmenopausal hormone users with mild systemic hypertension. Am. J. Cardiol., 78, 1385–1389.[Web of Science][Medline]
Pines, A., Fisman, E.Z., Averbuch, M. et al. (1996b). Left ventricular function during a short-term transdermal estradiol therapy in postmenopausal women: a double-blind placebo-controlled echocardiographic study. Eur. Menopause J., 3, 53–59.
Taskin, O., Gokdeniz, R., Muderrisoglu, H. et al. (1998). The effects of hormone replacement therapy on echocardiographic basic functions in postmenopausal women. Hum. Reprod., 13, 2399–2401.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||