Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome

Objectives: Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS. Methods: Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (E-p) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group. Results: Compared to controls, women with TS on HRT had higher PWV (9.1 +/- 2.4 vs. 7.5 +/- 0.5 m/s), cSBP (130 +/- 15 vs. 121 +/- 6 mmHg), cIMT (0.66 +/- 0.06 vs. 0.55 +/- 0.05 mm), aortic stiffness index, E-p and LA strain, and lower FMD (7.2 +/- 4 vs. 10.5 +/- 2.3%), Ao strain, Ao distensibility and GLS (-18.8 +/- 2.7 vs. -21.9 +/- 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 +/- 6 vs. 7.2 +/- 4%) and reduced PWV (7.8 +/- 1.7 vs. 9.1 +/- 2.4 m/s) and cSBP (123 +/- 14 vs. 130 +/- 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons). Conclusions: HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

Automated summary

The study showed that women with TS on HRT had increased cardiovascular risk factors, higher arterial stiffness and central arterial blood pressure, poor endothelial function, and impaired myocardial deformation. After discontinuation of HRT, endothelial function improved, arterial stiffness and central arterial blood pressure decreased, with no significant changes in myocardial deformation.