Emine Tuğçe ŞAHİN, Gülsüm Meral YILMAZ ÖZTEKİN, Ahmet GENÇ, Anıl ŞAHİN, Mehmet ÖZEN

Perimenopozal dönemin kalp yetersizliği seyrine etkileri

Amaç: Kadın yaşamında östrojen seviyesindeki düşüşün kardiyovasküler sistem üzerinde olumsuz etkileri olduğu bilinmektedir. Bu çalışmada, kalp yetersizliği (KY) olan hastaların menopoza geçiş döneminde klinik durumlarındaki değişikliklerin ve tedavi gereksinimlerinin aydınlatılması amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif, tek merkezli çalışmaya 2015-2020 yılları arasında KY polikliniğinde takip edilen toplam 26 hasta dahil edildi. Hastaların demografik verileri, New York Heart Association fonksiyonel sınıfı, ekokardiyografik bulguları, rutin biyokimyasal parametreleri ile KY belirti, semptom ve tedavileri incelendi. Menopoz döneminin başlangıcındaki ve 12 ay sonraki veriler karşılaştırıldı. Bulgular: 12 aylık takip sonunda, kullanılan günlük furosemide dozunda (50,5 mg/gün vs. 72,4 mg/gün) istatistiksel olarak anlamlı bir artış bulundu. Hastaların ortalama kalp hızı başlangıçta 80,4±20,1 atım/dk iken, 12 aylık takip sonunda 69,3±10,1 atım/dk idi. Hastaların ekokardiyografik olarak ölçülen sol ventrikül (LV) sistolik çapları, kontrol vizitinde başlangıca göre önemli ölçüde arttı (41,2±7,4 vs. 45,8±7,0 mm). Sonuç: Çalışmamızda KY ile takip edilen hastalarda, menopozal dönemin tedavi ihtiyacında artışa neden olduğu belirlendi. Bu nedenle KY hastalarının değerlendirilmesinde menopozal durumun ayrıntılı olarak sorgulanması ve menopoza geçiş döneminde hastaların daha yakından takip edilmesi yararlı bir yaklaşım olacaktır.

Anahtar Kelimeler:

Kalp yetersizliği, Menopoz, Östrojen

Effects of the perimenopausal period on the course of heart failure

Purpose: It is known that the decrease in estrogen level in women's life has negative effects on the cardiovascular system. In this study, it was aimed to elucidate the changes in the clinical status and treatment requirement of patients with heart failure (HF) during the menopausal transition period. Materials and Methods: A total of 26 patients followed up in the HF outpatient clinic between 2015–2020 were included in this retrospective, single-center study. Demographic data of the patients, New York Heart Association class, echocardiographic findings, routine biochemical parameters and HF signs, symptoms and therapies were examined. Data at the beginning of the menopause period and after 12 months were compared. Results: At the end of the 12-month follow-up, a statistically significant increase was found in the daily dose of furosemide (50.5 mg/day vs. 72.4 mg/day). While the mean heart rate of the patients was 80.4±20.1 beats/min at the beginning, it was 69.3±10.1 beats/min in the control visit. Echocardiographically measured left ventricular (LV) systolic diameters of the patients were significantly increased compared to baseline in the control visit (41.2±7.4 mm vs 45.8±7.0 mm,). Conclusion: The menopausal period caused an increase in the need for treatment in patients followed up with HF. Therefore, in evaluation of the patients with HF, it would be a useful approach to question the menopausal status in detail and to follow the patients more closely during the menopausal transition period.

Keywords:

Estrogen, heart failure, menopause,

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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599-726.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017;136:137-61.
Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021;23:352-80.
Braunwald E. Heart failure. JACC Heart Fail. 2013;1:1-20.
Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015;99:521-34.
Shufelt CL, Pacheco C, Tweet MS, Miller VM. Sex-specific physiology and cardiovascular disease. Adv Exp Med Biol. 2018;1065:433-54.
Knowlton AA, Lee AR. Estrogen and the cardiovascular system. Pharmacol Ther. 2012;135:54-70.
Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M et al. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography guidelines update. J Am Soc Echocardiogr. 2018;31:241-74.
Sinan ÜY, Ekmekçi A, Özbay B, Akyıldız Akçay F, Bekar L, Koza Y et al. The real-life data of hospitalized patients with heart failure: On behalf of the Journey HF-TR study investigators. Anatol J Cardiol. 2019;21:25-30.
Yılmaz MB, Aksakal E, Aksu U, Altay H, Nesligül Y, Çelik A et al. Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality. Anatol J Cardiol. 2020;23:160-8.
Singh A, Kaur S, Walia I. A historical perspective on menopause and menopausal age. Bull Indian Inst Hist Med Hyderabad. 2002;32:121-35.
Hamdi Kara I, Aydin S, Gemalmaz A, Akturk Z, Yaman H, Bozdemir N et al. Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study) Int J Vitam Nutr Res. 2007;77:389-397.
Kurt, G., Arslan, H. "Kadınların menopoz döneminde yaşadıkları sağlık sorunları ve baş etme yöntemleri". Cukurova Medical Journal. 2020;45:910-20
Gordon T, Kannel WB, Hjortland MC, McNamara PM. Menopause and coronary heart disease: the Framingham Study. Ann Intern Med. 1978;89:157-61.
Schipper I, Louwers YV. Premature and early menopause in relation to cardiovascular disease. Semin Reprod Med. 2020;38:270-6.
Rahman I, Åkesson A, Wolk A. Relationship between age at natural menopause and risk of heart failure. Menopause, 2015;22:12-6.
O'Donnell E, Floras JS, Harvey PJ. Estrogen status and the renin angiotensin aldosterone system. Am J Physiol Regul Integr Comp Physiol. 2014;307:498-500.
Subramanya V, Zhao D, Ouyang P, Lima JA, Vaidya D, Ndumele CE et al. Sex hormone levels and change in left ventricular structure among men and post-menopausal women: The Multi-Ethnic Study of Atherosclerosis (MESA). Maturitas, 2018;108:37-44.
Zilberman JM. Menopausia: hipertension arterial y enfermedad vascular [Menopause: hypertension and vascular disease]. Hipertens Riesgo Vasc. 2018;35:77-83.
Staessen JA, Celis H, Fagard R. The epidemiology of the association between hypertension and menopause. J Hum Hypertens. 1998;12:587-92.
Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D et al. Writing Group of the International Menopause Society for World Menopause Day 2012. Understanding weight gain at menopause. Climacteric. 2012;15:419-29.
Amirzadegan A, Salimi E, Hosseinsabet A. Are prolactin serum levels and coronary artery atherosclerosis correlated in postmenopausal women? A cross-sectional study. Turk Kardiyol Dern Ars. 2019;47:177-84.
Greendale GA, Sternfeld B, Huang M, , Han W, Karvonen-Gutierrez C, Ruppert K et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4:1248-65.
Klassen SA, Joyner MJ, Baker SE. The impact of ageing and sex on sympathetic neurocirculatory regulation. Semin Cell Dev Biol. 2021;116:72-81.
Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19:1574-85.
Smith GL, Vaccarino V, Kosiborod M, Lichtman JH, Cheng S, Watnick SG et al. Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail. 2003;9:13-25.