POSTMENOPAUSAL HORMONE REPLACEMENT AND CARDIOVASCULAR HEMODYNAMICS/BLOOD VOLUME

激素替代治疗逆转了心搏量的下降 在绝经后妇女中。 这种影响是否与 血容量或直接心肌效应是未知的。 因此我们 检查了单独的激素替代成分，17 -雌二醇（E， 雌激素）和醋酸甲羟孕酮（P，一种孕酮）， 二维和多普勒对心功能影响 超声心动图，并将这些结果与血浆和 血容量 18名健康绝经后妇女接受P（Provera，5 mg/d） 2个月，然后是2个月的序贯E（Estrace，1 mg/天） 在每个月的最后12天使用Provera 10 mg/天。 志愿者 开始激素治疗前、P治疗8周后、14周后 E期间16周，E + P期间16周后。 使用125 I-白蛋白稀释液在基线和 其他三个时间点。 P单独增加舒张末期容积（EDV）4.5%，每搏输出量（SV） 6.6%，左心室质量（LVM）比基线增加5%（所有p<0.05）， 但对心输出量（CO）无明显影响。 在E处理期间， 与基线相比，CO增加10%，SV增加10%，LVM增加6.5%（所有 p<0.05）。 E + P组合产生的变化最大，为12.8%。 CO增加，SV增加11.7%，EDV增加7.2%，降低10.2% 收缩末期容积（ESV）增加10.9%，射血分数（EF）增加10.9%， LVM增加9.4%（均p<0.05）。 显著增加 期间血容量（5.2%）和血浆容量（4.8%）较基线增加 治疗（分别为p<.001和<.01），这可以解释 心输出量增加，但射血分数没有增加。 在 结论，联合激素替代疗法导致适度，但 心输出量和左心室射血功能显著增加 分数 综合考虑，这些数据支持直接心肌效应 不依赖于前负荷的激素替代。

Hormone replacement therapy reverses the decline in stroke volume evident in postmenopausal women. Whether this effect is related to changes in blood volume or to a direct myocardial effect is unknown. Accordingly, we examined individual hormone replacement components, 17 - estradiol (E, and estrogen) and medroxyprogesterone acetate (P, a progestin), for their effect on cardiac function by 2-dimensional (2-D) and Doppler echocardiography, and correlated these findings to measures of plasma and blood volume. Eighteen healthy postmenopausal women received P (Provera, 5 mg per day) for 2 months, followed by 2 months of sequential E (Estrace, 1 mg per day) with Provera 10 mg/day for the last 12 days of each month. Volunteers had echocardiograms before starting hormones, after 8 weeks of P, after 14 weeks during E, and after 16 weeks during E + P. Plasma and blood volume were measured using 125I-albumin dilution at baseline and during one of the other 3 time points. P alone increased end diastolic volume (EDV) by 4.5%, stroke volume (SV) by 6.6%, and left ventricular mass (LVM) by 5% over baseline (all p<0.05), but had no significant effect on cardiac output (CO). During E treatment, CO increased by 10%, SV by 10%, and LVM by 6.5% over baseline (all p<0.05). Combination E + P produced the largest changes, with a 12.8% increase in CO, 11.7% increase in SV, 7.2% increase in EDV, 10.2% decrease in end systolic volume (ESV), 10.9% increase in ejection fraction (EF), and a 9.4% increase in LVM (all p<0.05). There was a significant increase in blood volume (5.2%) and plasma volume (4.8%) from baseline during treatment (p<.001 and <.01, respectively), which could explain the increased cardiac output but not the increased ejection fraction. In conclusion, combination hormone replacement therapy results in modest but significant increases in cardiac output and left ventricular ejection fraction. Taken together, these data support a direct myocardial effect of hormone replacement that is preload-independent.