This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 38/7/2048    most recent STROKEAHA.106.480426v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hogue, C. W. Articles by Dávila-Román, V. G. Search for Related Content PubMed PubMed Citation Articles by Hogue, C. W., Jr Articles by Dávila-Román, V. G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ESTRADIOL Medline Plus Health Information Heart Surgery Related Collections Behavioral/psychosocial - CV surgery

(Stroke. 2007;38:2048.)
© 2007 American Heart Association, Inc.

Original Contributions

Neurocognitive Outcomes Are Not Improved by 17ß-Estradiol in Postmenopausal Women Undergoing Cardiac Surgery

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

From the Department of Anesthesiology and Critical Care Medicine (C.W.H., Jr), Johns Hopkins University Medical School, Baltimore, Md; the Departments of Psychiatry (K.F., T.H., S.B.) and Neurology (R.F., A.N.), the Cardiovascular Division, Department of Medicine (B.B., V.G.D.-R.), the Department of Anesthesiology (B.T.), and the Division of Biostatistics, Department of Medicine (D.D., K.B.S.), Washington University School of Medicine, St. Louis, Mo.

Correspondence to Charles W. Hogue, Jr, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Tower 711, Baltimore, MD 21287. E-mail chogue2{at}jhmi.edu

Background and Purpose— Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17ß-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 17ß-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 17ß-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 17ß-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17ß-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17ß-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions.

Conclusions— Perioperative treatment with 17ß-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.

Key Words: cardiac surgery • cognitive impairment • estrogen • neuroprotective agents

This article has been cited by other articles:

				J. D. Stearns, V. G. Davila-Roman, B. Barzilai, R. E. Thompson, K. L. Grogan, B. Thomas, and C. W. Hogue Jr Prognostic Value of Troponin I Levels for Predicting Adverse Cardiovascular Outcomes in Postmenopausal Women Undergoing Cardiac Surgery Anesth. Analg., March 1, 2009; 108(3): 719 - 726. [Abstract] [Full Text] [PDF]

				C. W. Hogue, R. Fucetola, T. Hershey, K. Freedland, V. G. Davila-Roman, A. M. Goate, and R. E. Thompson Risk Factors for Neurocognitive Dysfunction After Cardiac Surgery in Postmenopausal Women Ann. Thorac. Surg., August 1, 2008; 86(2): 511 - 516. [Abstract] [Full Text] [PDF]

				C. W. Hogue Jr, R. Fucetola, T. Hershey, A. Nassief, S. Birge, V. G. Davila-Roman, B. Barzilai, B. Thomas, K. B. Schechtman, and K. Freedland The Role of Postoperative Neurocognitive Dysfunction on Quality of Life for Postmenopausal Women 6 Months After Cardiac Surgery Anesth. Analg., July 1, 2008; 107(1): 21 - 28. [Abstract] [Full Text] [PDF]

				P. B. Gorelick and J. V. Bowler Advances in Vascular Cognitive Impairment 2007 Stroke, February 1, 2008; 39(2): 279 - 282. [Full Text] [PDF]

				Can Estrogen Improve Postsurgical Neurocognitive Outcomes? Journal Watch Women's Health, July 19, 2007; 2007(719): 5 - 5. [Full Text]