Endothelial Dysfunction Measures Do Not Predispose to Early Echocardiographic Parameters of Diastolic Dysfunction in Post-Menopausal Women

Background: The incidence of cardiovascular diseases (CVD) in women, particularly heart failure with preserved left ventricular ejection fraction (HFpEF), rises in the post-menopausal (PM) period. Endothelial dysfunction (ED) has emerged as a significant predictor of both CVD and HFpEF. However, data regarding ED and early diastolic dysfunction (DD) parameters in PM women are limited.

Aims: To evaluate the rates of ED and DD in PM women without prior CVD.

Methods: Single-center prospective study of PM women attending the Women’s Health Clinic. Patients with known CVD, left ventricular systolic dysfunction or receiving hormone-replacement treatment were excluded. ED was measured non-invasively using peripheral arterial tonometry. The assessment of DD was done with 19 echo-Doppler parameters in accordance with current ESC Guidelines.

Results: Included were 31 patients at a median age and age at menopause of 63 and 50 years, respectively. The prevalence of CVD risk factors such as hypertension, diabetes, and dyslipidemia was 51%, 10% and 61%, respectively. The rates of prior gestational complications such as gestational diabetes and pre-eclampsia were 7% and 17%. Median values of glycated hemoglobin and LDL-Cholesterol level were 5.7%, and 118mg/dL (interquartile range 92, 137), respectively. Fifty-two percent of women had DD (median E/A ratio<0.85). Values of other diastolic parameters, including left atrial size and pulmonary pressure were in the normal range. Twelve women (39%) had abnormal tonometry suggesting ED. However, the echo-Doppler parameters of DD did not differ between the groups categorized by the ED test.

Conclusions: Our cohort of relatively young PM women with no overt CVD and controlled CVD risk factors, demonstrated substantial rates of ED and early grade DD. These findings emphasize the limitations of CVD-risk assessment in PM women when traditional risk scores are used. Our findings did not establish a correlation between ED and echocardiographic DD parameters in PM women.