Measurement of aortic blood flow by magnetic resonance below and above the origin of the coronary arteries in postmenopausal hormone replacement therapy.
OBJECTIVE
Principal blood flow measures might be assessable by velocity-encoded cine magnetic resonance (VENC MR) of aortic blood flow. The feasibility of using VENC MR for clinical research was tested in a contemporary and controversial human model: the effects of 17beta-estradiol (E) and cyclic norethisterone acetate (NETA) in postmenopausal women.


METHODS
Sixteen postmenopausal women were included in a crossover study (two 12-week periods, 3-month washout) and randomized to E and NETA or placebo. Aortic blood flow (ABF) was measured eight times by VENC MR below and above the coronary arteries (CA) and was used for estimation of coronary artery blood flow (CABF) and peak flow velocity (Vmax). The calculated value of CABF was negative and was corrected by averaging systolic flow. Data were analyzed in a repeated measurement model including analysis of repeatability (CR) and group variability (CV).


RESULTS
The CR and CV of ABF were low (11% and 7%) and corresponded at the two levels. Vmax showed similar levels of reproducibility at the two levels. The coronary artery blood flow was less reproducible (39% and 31%). During treatment, ABF above CA was reduced after 12 weeks (p=0.03), ABF below CA was unchanged, and CABF was significantly increased without detrimental effects of NETA. Vmax was increased at NETA addition (p<0.01).


CONCLUSIONS
Aortic flow quantification by VENC MR is reproducible and useful for assessment of principal haemodynamic changes in smaller studies. Derived measurement of CABF lacks precision. Differences in change below and above CA indicate that oral high-dose E and NETA may induce coronary artery dilatation.
Sørensen
Morten Beck
MB
Department of Obstetrics and Gynecology, Hvidovre University Hospital of Copenhagen, Denmark. m.sorensen@rbh.nthames.nhs.uk
Fritz-Hansen
Thomas
T
Jensen
Henrik Halvor
HH
Pedersen
Anette Tønnes
AT
Ottesen
Bent
B
D001011:Aorta / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use; D003326:Coronary Circulation / Q000502:physiology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004958:Estradiol / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D009640:Norethindrone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077563:Norethindrone Acetate; D017698:Postmenopause; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D015203:Reproducibility of Results
D003280:Contraceptives, Oral, Synthetic; D004958:Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone