Sex hormones are associated with right ventricular structure and function: The MESA-right ventricle study

Abstract

Rationale: Sex hormones have effects on the left ventricle, but hormonal influences on the right ventricle (RV) are unknown.

Objectives: We hypothesized that sex hormones would be associated with RV morphology in a large cohort free of cardiovascular disease.

Methods: Sex hormones were measured by immunoassay and RV ejection fraction (RVEF), stroke volume (RVSV), mass, end-diastolic volume, and end-systolic volume (RVESV) were measured by cardiac magnetic resonance imaging in 1,957 men and 1,738 postmenopausal women. The relationship between each hormone and RV parameter was assessed by multivariate linear regression.

Measurements and main results: Higher estradiol levels were associated with higher RVEF (β per 1 ln[nmol/L], 0.88; 95% confidence interval [CI], 0.32 to 1.43; P = 0.002) and lower RVESV (β per 1 ln[nmol/L], -0.87; 95% CI, -1.67 to -0.08; P = 0.03) in women using hormone therapy. In men, higher bioavailable testosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.97; 95% CI, 0.20 to 3.73; P = 0.03) and greater RV mass and volumes (P ≤ 0.01). Higher dehydroepiandrosterone levels were associated with higher RVSV (β per 1 ln[nmol/L], 1.37; 95% CI, 0.15 to 2.59; P = 0.03) and greater RV mass (β per 1 ln[nmol/L], 0.25; 95% CI, 0.00 to 0.49; P = 0.05) and volumes (P ≤ 0.001) in women.

Conclusions: Higher estradiol levels were associated with better RV systolic function in women using hormone therapy. Higher levels of androgens were associated with greater RV mass and volumes in both sexes.

Figure 1.

Study sample. DHEA = dehydroepiandrosterone; LV = left ventricle; MESA = Multi-Ethnic Study of Atherosclerosis; MRI = magnetic resonance imaging; RV = right ventricle.

Figure 2.

Natural log–transformed estradiol [ln(E2)] parameter estimates with 95% confidence intervals for right ventricular ejection fraction (RVEF) stratified by hormone therapy use in limited and adjusted regression models (women only). *Adjusted for age, race/ethnicity, height, weight, waist circumference. **Adjusted for age, race/ethnicity, height, weight, waist circumference, smoking (status and pack-years), diabetes mellitus, impaired glucose intolerance, hypertension, use of antihypertensive medications, systolic and diastolic blood pressure, cholesterol, high density lipoprotein levels, statin use, intentional exercise, and level of education. HT = hormone therapy; LV = left ventricle.