Acute changes in circulating hormones in older patients with impaired ventricular function undergoing on-pump...

Area of Science:

• Endocrinology
• Cardiovascular Surgery
• Geriatrics

Background:

• Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) triggers an acute stress response.
• Hormonal changes during CPB may contribute to complications in older adults undergoing CABG.
• Investigating these hormonal shifts is crucial for understanding post-operative recovery in the elderly.

Purpose of the Study:

• To examine alterations in circulating anabolic and catabolic hormones in elderly patients during and after CABG with CPB.
• To identify specific hormonal changes associated with the acute stress response to cardiac surgery in older individuals.

Main Methods:

• An intervention case study design was employed.
• Hormone levels (Cortisol, DHEA, DHEAS, LH, estradiol, total testosterone, SHBG, IGF-I) were measured in 19 elderly patients (aged 62-80) before and at multiple time points after CABG.
• Patients had coronary artery disease and reduced ejection fraction (<40%).

Main Results:

• Post-CABG surgery, serum Insulin-like Growth Factor-I (IGF-I) levels significantly decreased (p<0.001) in both sexes.
• Cortisol (Cort), Dehydroepiandrosterone sulfate (DHEAS), and estradiol (E2) levels significantly increased in both men and women.
• Total testosterone (Te) levels showed sex-specific changes: a significant decline in men and a significant increase in women.

Conclusions:

• CABG with CPB induces significant hormonal alterations in elderly patients, including a marked decrease in testosterone in older men and a decline in IGF-I in both sexes.
• Elevated cortisol levels were observed in both sexes following the procedure.
• These hormonal shifts may partially account for the extended rehabilitation period required by elderly patients after CABG.