Neurocognitive outcomes are not improved by 17β-estradiol in postmenopausal women undergoing cardiac surgery

Charles W. Hogue*, Kenneth Freedland, Tamara Hershey, Robert Fucetola, Abullah Nassief, Benico Barzilai, Betsy Thomas, Stanley Birge, David Dixon, Kenneth B. Schechtman, Victor G. Dávila-Román

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

BACKGROUND AND PURPOSE - Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17β-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 17β-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 17β-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 17β-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17β-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17β-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions. CONCLUSIONS - Perioperative treatment with 17β-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.

Original languageEnglish (US)
Pages (from-to)2048-2054
Number of pages7
JournalStroke
Volume38
Issue number7
DOIs
StatePublished - Jul 1 2007

Keywords

  • Cardiac surgery
  • Cognitive impairment
  • Estrogen
  • Neuroprotective agents

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Hogue, C. W., Freedland, K., Hershey, T., Fucetola, R., Nassief, A., Barzilai, B., Thomas, B., Birge, S., Dixon, D., Schechtman, K. B., & Dávila-Román, V. G. (2007). Neurocognitive outcomes are not improved by 17β-estradiol in postmenopausal women undergoing cardiac surgery. Stroke, 38(7), 2048-2054. https://doi.org/10.1161/STROKEAHA.106.480426