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Published on: August 13, 2019
Neurocognitive outcomes are not improved by 17beta-estradiol in postmenopausal women undergoing cardiac surgery
Charles W Hogue1, Kenneth Freedland, Tamara Hershey
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA. chogue2@jhmi.edu
Insights
Perioperative 17beta-estradiol did not improve neurocognitive dysfunction in postmenopausal women after cardiac surgery. Cognitive function, specifically psychomotor speed, was worse in the 17beta-estradiol group.
Area of Science:
- Cardiology
- Neurology
- Endocrinology
Background:
- Neurocognitive dysfunction is a significant complication following cardiac surgery, particularly impacting postmenopausal women.
- 17beta-estradiol has shown neuroprotective effects in experimental models of ischemic neuronal injury.
Purpose of the Study:
- To determine if perioperative 17beta-estradiol administration reduces neurocognitive dysfunction in postmenopausal women undergoing cardiac surgery.
- To evaluate the effect of 17beta-estradiol on neurocognitive outcomes after coronary artery bypass graft and/or valve surgery.
Main Methods:
- A double-blind, randomized controlled trial involving 174 postmenopausal women not on hormone replacement therapy.
- Participants received either 17beta-estradiol or placebo perioperatively (starting day before surgery, continuing for 5 days postoperatively).
- Neurocognitive function was assessed using the National Institutes of Health Stroke Scale and a psychometric test battery before and after surgery.
Main Results:
- No significant difference in the frequency of neurocognitive dysfunction between the 17beta-estradiol and placebo groups at 4-6 weeks post-surgery (22.4% vs. 21.4%, P=0.45).
- Patients receiving 17beta-estradiol demonstrated worse mean scores in psychomotor speed tests compared to the placebo group at the 4-6 week postoperative assessment (P=0.005).
Conclusions:
- Perioperative 17beta-estradiol treatment did not improve neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.
- The study suggests a potential negative impact of 17beta-estradiol on psychomotor speed in this patient population.
Background And Purpose:
Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17beta-Estradiol limits the extent of ischemic neuronal injury in a variety of experimental models. The purpose of this study was to evaluate whether perioperative administration of 17beta-estradiol to postmenopausal women reduces the frequency of neurocognitive dysfunction after cardiac surgery.
Methods:
One hundred seventy-four postmenopausal women not on estrogen replacement therapy who were undergoing primary coronary artery bypass graft surgery and/or valve surgery with cardiopulmonary bypass were prospectively randomized to receive in a double-blinded manner either 17beta-estradiol or placebo beginning the day before surgery and continuing for 5 days postoperatively. The patients were evaluated before and after surgery with the National Institutes of Health Stroke Scale and a psychometric test battery.
Results:
There were no differences in the frequency of neurocognitive dysfunction (primary outcome) between patients randomized to perioperative 17beta-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17beta-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17beta-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions.
Conclusions:
Perioperative treatment with 17beta-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.
