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

Abstract

We aimed to compare the effects of new treatment modalities to conventional hormone replacement therapy (HRT) on left ventricular (LV) diastolic function, by means of conventional and tissue Doppler echocardiography and the myocardial integrated backscatter (IBS) in postmenopausal women. One hundred and fifty healthy postmenopausal women were included in this study. Subjects were assigned to one of the five groups receiving 1 year of treatment (estrogen, estrogen plus progesterone, raloxifene, tibolone or placebo). E and A wave velocity, E/A ratio, isovolumic relaxation time (IVRT), deceleration time (DT), peak early (Em) diastolic mitral annular velocity, E/Em ratio, the cyclic variation of integrated backscatter (CVIBS) and the mean value of the IBS signal (MIBS) were determined before and 12 months after therapy. E (76 +/- 10 vs. 98 +/- 8 cm/s, P = 0.0001 and 78 +/- 10 vs. 90 +/- 12 cm/s, P = 0.02, respectively), Em (14.3 +/- 2.4 vs. 16.4 +/- 2.5 cm/s, P = 0.001 and 15.1 +/- 3.4 vs. 16.2 +/- 3.5 cm/s, P = 0.01, respectively), and E/A ratio (1.15 +/- 0.3 vs. 1.42 +/- 0.4, P = 0.0001 and 1.0 +/- 0.2 vs. 1.22 +/- 0.2, P = 0.01, respectively) were increased significantly compared to pretreatment in both estrogen and raloxifene groups while DT, A, E/Em, and IVRT were significantly decreased. A significant increase in CVIBS and decrease in MIBS were detected 12 months after estrogen and raloxifene administration while no significant changes were observed in other groups. Changes in the MIBS and CVIBS were found to be independently associated with the observed changes in the diastolic function indexes during therapy. Both estrogen and raloxifene regimens may improve LV diastolic functions in healthy postmenopausal women. This improvement may be a result of direct cardiac effects on LV myocardium.

Cardiac Adaptations to High‐Intensity Aerobic Training in Premenopausal and Recent Postmenopausal Women: The Copenhagen Women Study

“…Another possibility is that estrogen loss is more important for vascular function than for cardiac impairments, for which age may be a more influential factor. However, previous studies have shown that estrogen treatment improves diastolic function in postmenopausal women . Thus, at least with time, estrogen is likely to also impact cardiac function.…”

“…However, previous studies have shown that estrogen treatment improves diastolic function in postmenopausal women. 39,40 Thus, at least with time, estrogen is likely to also impact cardiac function. TDI and 2-dimensional speckle tracking used in the examinations of the participants allows for a more sensitive measure of early subclinical changes in systolic and diastolic function.…”

Detection of early radiotherapy‐induced changes in intrinsic myocardial contractility by ultrasound tissue characterization in patients with early‐stage breast cancer

“…In a clinical setting, Duygu et al. recently demonstrated that estrogen replacement therapy in healthy postmenopausal females increased CVIBS values …”

Cardiac Mechanics in Altered Hormonal States as a Surrogate for Understanding the Effects of Transgender Hormone Therapy

“…44 A similarly designed prospective study of 150 healthy cisgender postmenopausal women also found that the HRT-receiving group (taking 0.625 mg of conjugated estrogen with or without 2.5 mg medroxyprogesterone acetate) had increased E/A ratio and decreased E/e′ compared to the control group after 1 year of treatment. 45 These findings are corroborated by older clinical trials featuring standardized HRT regimens from 2003 and 2004. 46,47 The observational and clinical trials referenced above suggest that exogenous estrogen combined with progestins as part of feminizing GAHT in transgender women may cause changes in diastolic parameters on echocardiography (Table 4).…”