Publikationsserver der RWTH Aachen University
Myokardiale Expression von Estrogenrezeptoren bei Patienten mit angeborenem Herzfehler
Abstract
dc:descriptionWe examined 20 patients (7 female, 13 male, age: median: 166.5 months, minimum: 3 months, maximum: 319 months) with congenital heart defect who had received heart surgery. To analyse sex-specific influence on the postoperative organ protection, we examined the myocardial expression of the estrogen receptor a&b (ERa&b) which we confronted with the expression of BNP, the emission of the Troponin T and the postoperative course. We could prove, that the infantile myocardium expresses ERa&b. Thereby we found out that the expressions of both receptors strictly correlate with one another, so it may be possible, that they are regulated by a common external factor or by each other. It appeared, that the expression of the receptors showed no connection with the age or gender of our patients. Besides we proved with all our patients BNP-RNA in the right atrium. Here, we also could not assess any connection between age, gender and the BNP expression. Another important point of our study is the first-time proof of a correlation between the expression of ERa&b and that of BNP. So far, only a connection of the expression for atrial natriuretic peptid had been proven. However, it is fact that BNP in the plasma of women is higher. Further research is necessary to identify through which mechanisms the ERs exert influence on the BNP expression, or whether they are adjusted by a common external factor. Another part of our study was the collection of clinical data in the preoperative phase, during the operation as well as four and 24 hours after the operation. There exist many hypotheses, that E2, through ERa&b, has protective effects on the various organ systems. In many clinical situations, an advantage in the outcome for women in comparison to men of the same age has been reported. However, in the cardiac surgery, high pre- and postoperative BNP-plasma levels are equated with a higher morbidity and mortality. We examined, if the expression of the ERs and BNP shows a connection with our clinical data. Thereby we found:- a significantly higher oxygenation of our patients with higher expression of ERa&b or BNP at different points of time. - a negative correlation between the surgical score systems, the score 4h postoperative and the BNP expression. The score systems have been developed to be able to forecast the morbidity after cardiac surgery. A lower score value goes along with a lower risk of complications. Therefore a contrary statement seems to exist for the expression of BNP-RNA in comparison to the plasma values. - a negative correlation between the ERa expression and Troponin T in the blood. Troponin is a highly sensitive marker of a damage of the heart muscle. It is possible that a high expression of ERa has protective effects on the heart muscle. Finally, we analysed the clinical data of our patients with respect to their gender. Not only the expression of the receptors which did not differ significantly in our study, but also the estrogen plasma levels, other sex hormones and numerous other factors can cause differences between the sexes. We found two important differences:1) 24 hours after the operation, the male patients had a significant increase of the mean arterial pressure. Pre-menopausal women show a lower hypertension incidence than men of the same age. There are different hypotheses on how E2 lowers the blood pressure via genomic and non-genomic pathways and reduces a sympathetic activation of the heart. It is possible that the female subgroup was protected by E2 against a post-operative increase in blood pressure.2) The female subgroup had significant lower blood glucose levels 24 hours postoperative. There are hypotheses which suggest that E2 influences the glucosehomeostasis through genomic and non-genomic pathways. A strict setting of the postoperative blood glucose levels is equated with a lower postoperative morbidity. It is therefore possible, that E2 has protective effects by lowering blood glucose.Our work makes clear, that the molecular effects of sex hormones and the role of different receptors offer a wide field for additional research. Consequently, it may be possible in the future, to use protective effects through specific receptor agonists therapeutically.
Degree
thesis:*- Grantor dc:publisher
- Publikationsserver der RWTH Aachen University
- Year dc:date
- 2010
Author and committee
dc:creator, dc:contributor.*- Author dc:creator
-
- Faber, Julia
- Contributors dc:contributor
-
- Seghaye, Marie-Christine
Subjects
dc:subject × 9Rights
dc:rights- Statement dc:rights
-
- info:eu-repo/semantics/openAccess
- Language dc:language
- ger