Association of earlier menopause with myocardial remodeling: a cardiovascular magnetic resonance imaging study

Sex differences in cardiovascular disease (CVD) have been increasingly recognized, where females may have specific factors that may influence CVD risk (1). Early onset menopause is associated with a higher incidence of CVD and randomized trials testing exogenous hormonal therapy have been conducted with the aim of reducing this risk (2). Compared with females who had naturally occurring menopause at age 50–51 years, those with premature ( < 40 years), early menopause ( < 45 years), and subsequent deficiency of estrogen (3) have an increased risk for adverse events, including heart failure and mortality, before the age of 60 (2). A total of 44 females without previous history of CVD were categorized into 2 groups: earlier menopause (n=22) and aged-matched healthy controls with naturally occurring (regular) menopause (n=22). Demographic and CMR data of all participants were collected (Table 1 & 2). Statistical analysis was performed using Microsoft Excel statistical software 2016 (Baton Rouge, United States). Categorical data were expressed as percentages and continuous variables as mean± SD. Unpaired t-test was used to compare parametric variables, with a p-value < 0.05 indicating statistical significance. The mean age of females with earlier and regular menopause were 55.8 ± 8.36 and 55± 9.1 years, respectively (p value= 0.74). The age of menopause onset was significantly lower in those with earlier menopause (39.8±5.8 years) compared to females with regular menopause (50.9± 4.3 years; p value < 0.001) (Table 1). Mean T1 mapping values were significantly higher in earlier menopause group (1223.4± 48.5 msec), compared to regular menopause (1181.9± 38.0 msec; p value=0.003) (Figure 1, A). Mean T2 values were also significantly higher in females with earlier menopause (47.5± 5.7 seconds) versus the regular menopause (43.7± 4.4 msec; p value=0.031) (Figure 1, B). There were no significant differences between left ventricle ejection fraction, global longitudinal strain, and maximum left atrium volume in both groups (p values=0.22, 0.16, and 0.31, respectively) (Table 2). Compared to females with regular menopause, those with history of earlier menopause demonstrate abnormal myocardial tissue characterization, including increased markers of diffuse fibrosis and inflammation on CMR imaging. These subclinical findings may be potential mechanism linking premature cardiovascular disease to menopause.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)