Seeking greater insight on the variations in cardiac structure, heart failure (HF), and related outcomes between women and men, a new study from Taiwan investigated possible influences from menopause and the resulting lack of estrogen, according to study findings published recently in Frontiers in Cardiovascular Medicine.

For this subanalysis from a larger study of 4051 consecutive patients with no history of heart HF receiving care at Mackay Memorial Hospital, the authors compared outcomes between 749 premenopausal women (mean [SD] age, 42.7 [7.3] years) and 669 postmenopausal women (mean age, 60.8 [7.2] years). Menopause was defined to be more than 1 year of no menstrual periods. All of the participants were evaluated via ultrasound for left ventricular (LV) end-diastolic and end-systolic diameters, wall dimensions, LV and left atrial (LA) chamber volumes, and LV ejection fraction (LVEF). LV mass was also calculated.

“To date, no study has comprehensively looked at the relationship between menopause, circulating estradiol levels, and atrioventricular deformation measures,” the authors wrote. “Therefore, we investigated the association between sex, menopause, and increasing years of menopause on cardiac (LA and LV) geometry and mechanics in a large asymptomatic population.”

Overall, mean global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) were shown to be reduced among the postmenopausal women—compared with their premenopausal counterparts—and their LA stiffness, LV sphericity, and LV torsion were increased:

• GLS: 20.34% (2.00%) vs 21.33% (1.85%)
• PALS: 34.7% (7.9%) vs 40.9% (7.4%)
• LA stiffness: 0.30% (0.14%) vs 0.19% (0.07%)
• LV sphericity: 0.63 (0.06) vs 0.60 (0.07)
• LV torsion: 2.62 (1.01) vs 2.10 (0.88) degrees/cm

A multivariable analysis that accounted for age, body mass index, heart rate, systolic and diastolic blood pressures, fasting blood glucose, total cholesterol, high-density lipoprotein, estimated glomerular filtration rate, hypertension, diabetes, coronary artery disease (CAD), and smoking status demonstrated adverse cardiac function outcomes among the postmenopausal women.

For every 5 years of menopause, independent associations were seen for the following:

• Greater LV sphericity: 0.02 (95% CI, 0.01-0.03)
• Lower LV GLS: 0.37 (95% CI, 0.04-0.70)
• Worse PALS by about 2.4-fold
• Increased LA stiffness: 0.028 (95% CI, 0.01-0.05)

Regarding how menopause and lack of estrogen affect HF-related outcomes—5.5% of the postmenopausal women developed HF over 2.9 years of follow-up—increased LV sphericity (adjusted HR [aHR], 1.04; 95% CI, 1.00-1.07), impaired GLS (aHR, 0.87; 95% CI, 0.78-0.97), decreased PALS (aHR, 0.94; 95% CI, 0.90-0.99), and increased LA stiffness (aHR, 10.5; 95% CI, 1.69-64.6) were shown to be independently associated with greater risks of HF-related hospitalizations. PALS below 23% (aHR, 1.32; 95% CI, 1.01-3.49) and GLS less than 16% (aHR, 5.80; 95% CI, 1.79-18.8) continued to be associated with HF even after dichotomous analyses.

There were 102 HF events and 113 composite end points of all-cause death and incident HF overall among the postmenopausal group.

In addition, the more years a woman had been in menopause, the greater the likelihood her GLS, LA mechanics, and LV torsion would worsen. This group also had higher blood pressure and fasting glucose, worse lipid profiles and renal function, and greater prevalence of hypertension, diabetes, hyperlipidemia, and CAD.

“Our results extend prior data by showing that independent of age and cardiovascular risk factors, female menopause is associated with greater LV and LA structural remodeling in tandem with subtle declines in LV and LA longitudinal deformation, despite preserved LVEF,” the authors wrote. “Our study further adds that postmenopausal women exhibit lower longitudinal atrial mechanics and increased atrial stiffness, consistent with the known predisposition of elderly women to LV diastolic dysfunction despite preserved LVEF and atrial fibrillation.”

Their findings, they conclude, may lend clarification to the sex differences in heart failure between men and women, but more study is needed.

Reference

Sung K-T, Chandramouli C, Lo C-I, et al. Association of female menopause with atrioventricular mechanics and outcomes. Front Cardiovasc Med. Published online April 21, 2022. doi:10.3389/fcvm.2022.804336