Ventricular Repolarization in Patients With Premature Ovarian Insufficiency (QT-IOP)

Study Overview
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Brief Summary
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Ventricular repolarization, measured by corrected QT interval (QTc), is influenced by sex hormones. A QTc above 460msec predisposes to the risk of torsades-de-pointes(TdP). The investigators have recently shown that estradiol determines an increase in QTc elongation and progesterone shortens it. In addition, high gonadotropin levels (FSH or LH) are associated with QTc prolongation. Hypergonadotropic hypogonadisms (low progesterone and high gonadotropins) are therefore hormonal situations that promote QTc prolongation. Premature ovarian insufficiency (POI) is one of them. Its management is based on the prescription of hormone replacement therapy (HRT). Epidemiological studies have shown that these patients would be at increased risk of cardiovascular mortality. Our team is interested in the effect of this pathological hormonal situation and its HRT on ventricular repolarization in order to define whether this is a population at risk for long QTc.

Detailed Description
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Ventricular repolarization, measured by the duration of the heart rate corrected QT interval (QTc), is influenced by sex hormones. A QTc above 460msec predisposes to the risk of torsades-de-pointes (TdP); ventricular arrhythmias that can lead to sudden death. From puberty to menopause, QTc is longer in women than in men ( 10-15msec difference) and varies in women according to the menstrual cycle ( 5-10msec). This explains the increased risk of TdP in women compared to men. During the menstrual cycle, the risk is highest for women during the follicular phase compared to the luteal phase. The investigators have recently shown that estradiol determines an increase in QTc elongation and progesterone shortens it. In addition, high gonadotropin levels (FSH or LH) are associated with QTc prolongation. Hypergonadotropic hypogonadisms (low progesterone and high gonadotropins) are therefore hormonal situations that promote QTc prolongation. Premature ovarian insufficiency (POI) affects 1% of women under 40 years of age and is characterized by hypergonadotropic hypogonadism. POI is associated with hormonal deficiencies responsible for amenorrhea and infertility. Management is based on the prescription of hormone replacement therapy (HRT). Epidemiological studies have shown that these patients would be at increased risk of cardiovascular mortality. HRT will be based on the combination of an estrogen and a progestin and will lead to a variable decrease in gonadotropins, depending on the steroid hormones/doses used. Our team, after structuring one of the largest international cohorts of patients with POI, is interested in the effect of this pathological hormonal situation and its HRT on ventricular repolarization to define whether this is a population at risk for long QTc. Indeed, ECG follow-up is recommended and many drugs (cardiovascular or not), are to be avoided, or even contraindicated in situations at risk of long QTc.

Official Title
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Study of Ventricular Repolarization in Patients With Premature Ovarian Insufficiency and Influence of Estrogen-progestin Replacement Therapy

Conditions
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Premature Ovarian Insufficiency

Intervention / Treatment
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* Drug: Hormone replacement therapy:effect on ventricular repolarization
* Diagnostic Test: ECG


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with POI Patient aged 18 to 40 years Patient with POI diagnostic criteria (FSH >25UI/l twice at intervals of a few weeks) with amenorrhea No hormone treatment interacting with the gonadotropic axis for at least one month before inclusion Patient who has signed informed consent Patient affiliated to a social security system Healthy volunteers (including POI control group) Healthy women, aged 18 to 40 years, age-matched (+/- 5 years), and by BMI class (BMI<18, 18-25, 25-30, 30-35, 35-40, >40) compared to women with BPI Women with regular cycles of 26 to 32 days Women who has signed an informed consent form Patient affiliated to a social security system Exclusion Criteria: Patients with POI Patient on HRT during the 1st evaluation Pregnant or breastfeeding woman Treatment regimen known to lengthen QT or act on ventricular repolarization Cardiac history in particular cardiac rhythm disorder Diabetes Patient on AME (unless derogation from affiliation), Severe renal insufficiency (MDRD <30ml/min/m²) Healthy volunteers (including POI control group) Diabetes or any chronic disease (including cardiovascular and endocrine) Pregnant or breastfeeding woman Hormonal contraceptive treatment in progress or stopped less than 3 months ago Chronic treatment affecting the duration of QTc Woman under AME (unless affiliation derogation)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This is a bicentric case-control study: 60 patients with POI followed in the endocrinology department, and 60 healthy volunteers matched with POI's patients on age (+/- 5 years), on BMI classes (BMI<18, 18-25, 25-30, 30-35, 35-40, >40) and with regular cycles (26 to 32 days).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Premature ovarian insufficiency<br>60 patients with POI followed in the endocrinology department | Drug: Hormone replacement therapy:effect on ventricular repolarization<br>* Hormone replacement therapy and QTc measurement<br>|
| Other: healthy volunteers<br>60 healthy volunteers matched with POI's patients | Diagnostic Test: ECG<br>* QTc measurement<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of QTc | Compare the duration of QTc in patients with non-substituted POI with that of matched healthy volunteers on cardiovascular risk factors. The QTc will be measured by the Fridericia method | in the luteal phase between Day22 and Day25 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of QTc | Measure the duration of QTc in women with POI before and after the introduction of HRT | the day before and between Day22 and Day60 after the introduction of HRT | 
| Duration of QTc | Study the association between sex hormone levels (gonadotropins, steroid hormones) and QTc duration, as well as their variation in patients with POI and healthy volunteers | in the luteal phase between Day22 and Day25 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Premature ovarian insufficiency, QTc, Torsade de pointe, Hormone replacement therapy