title: Neurocognitive outcomes are not improved by 17beta-estradiol in postmenopausal women undergoing cardiac surgery.
abstract: OBJECTIVE
  Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17beta-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 17beta-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 17beta-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 17beta-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17beta-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17beta-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions.
  
  
  CONCLUSIONS
  Perioperative treatment with 17beta-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA. chogue2@jhmi.edu
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hogue
authors.forename: Kenneth
authors.initials: K
authors.lastname: Freedland
authors.forename: Tamara
authors.initials: T
authors.lastname: Hershey
authors.forename: Robert
authors.initials: R
authors.lastname: Fucetola
authors.forename: Abullah
authors.initials: A
authors.lastname: Nassief
authors.forename: Benico
authors.initials: B
authors.lastname: Barzilai
authors.forename: Betsy
authors.initials: B
authors.lastname: Thomas
authors.forename: Stanley
authors.initials: S
authors.lastname: Birge
authors.forename: David
authors.initials: D
authors.lastname: Dixon
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Schechtman
authors.forename: Victor G
authors.initials: VG
authors.lastname: Dávila-Román
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D004958:Estradiol / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause; D016896:Treatment Outcome
chemical_list: D004958:Estradiol