Effects of Menopause on the Myocardial Velocities and Myocardial Performance Index

Abstract

enopause is a critical period in a woman's life, during which many physiologic and pathologic changes occur. Women spend one-third of their lifetime in this period and the hormonal changes that occur during this period have significant influences on several organs and systems. The cardiovascular system is among the most dramatically affected systems. Changes in cardiovascular risk factors due to estrogen deficiency and subsequent increase in cardiovascular morbidity and mortality have been demonstrated in several studies. [1][2][3] Structural and functional changes in the heart can also occur during the postmenopausal period. The effects of menopause on cardiac structure and function have not been investigated adequately. Interpretation of the results of the few previous studies 4-6 comparing pre-and postmenopausal women comprises some difficulties, owing to significant age differences and small sample sizes. Moreover, cardiac functions have been evaluated only by conventional 2-dimensional (D) and M-mode echocardiography in these studies, thus the extent of influence on more recent echocardiographic parameters after menopause have not been adequately analyzed.Tissue Doppler echocardiography (TDE) is a relatively new technique, which is partially utilized in recent years to evaluate cardiac functions via measurement of myocardial velocities. 7 Also, myocardial performance index (MPI) has been recognized as a parameter that reflects ventricular systolic and diastolic functions. 8,9 To our knowledge, no literature exists on how myocardial velocities, as measured by TDE, which have some advantages over standard echocardiographic methods, and MPI, which provides a more quantitative and global evaluation of left ventricular (LV), are affected by menopause. The present study was designed to investigate how myocardial velocities measured by TDE and MPI, which together provide more quantitative data on regional and global ventricular functions, are affected by menopause. Methods Study PopulationSubjects were selected from healthy women admitted to the gynecology and obstetrics, and cardiology outpatient departments between 2001 and 2006. After informed consent was obtained, a prospective analysis was performed. Body weight and height of all subjects were measured and body mass index was calculated. Fasting blood samples were drawn for biochemical and hematological investigations and ECGs were done. An exercise stress test using Bruce protocol and subsequent echocardiographic evaluations were performed. Postmenopausal status was confirmed as being in menopause for at least 12 months with serum follicle-stimulating hormone (FSH) levels of >30 mU/ml and estrogen levels of <20 pg/ml, and premenopausal status Effects of Menopause on the Myocardial Velocities and Myocardial Performance IndexMehmet Akif Düzenli, MD; Kurtulus Ozdemir, MD; Abdullah Sokmen, MD**; Ahmet Soylu, MD; Nazif Aygul, MD; Kazim Gezginc, MD*; Mehmet Tokac, MD Background Although menopause is known to increase cardiovascular risk and mortality, the effect ...

Menopausal cardiomyopathy: Does it really exist? A case–control deformation imaging study

“…In order to minimize bias, echocardiograms of both menopausal and premenopausal groups were performed by cardiologists blinded to the clinical data. In addition, this subclinical impairment in the myocardial functions shows a similarity with the previous studies performed with conventional imaging methods . Our study results demonstrate that LV functions may be impaired with the development of menopause, even in cases where conventional imaging methods do not show any difference.…”

“…Furthermore, studies have shown that menopause, characterized by markedly decreased levels of estrogen, leads to significant increases in cardiovascular mortality and morbidity . Although there are many studies focusing on the relationship between menopause and adverse cardiovascular events, the published work on cardiac structure and function is comprised of only a few studies . In these few studies, menopause has been shown to have an impact on cardiovascular structure and functions, however, these studies appear to have many limitations such as different age groups and lack of advanced echocardiography techniques.…”

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“…For this reason, the patients with diabetes mellitus were excluded from the study. Furthermore, females were excluded due to negative effects of menopause and ovulation phases on LV MPI . Another major limitation was lack of myocardial blush grading (MBG).…”

“…Furthermore, females were excluded due to negative effects of menopause and ovulation phases on LV MPI. 53 Another major limitation was lack of myocardial blush grading (MBG). Longer angiographic records and optimal opaque injection are required to obtain reliable angiographic views to assess MBG.…”

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“…Furthermore, changes have been observed in the structure and cardiac tissue as a result of pathological hypertrophy and increased fibrosis (1,9,22,55,76). All of these changes seem to contribute to the development of cardiac dysfunction, which is often observed in experimental and clinical studies (2,12,23,31,43,53).…”