Early subclinical left ventricular dysfunction after surgical menopause: a prospective speckle-tracking echocardiography study.

BACKGROUND

Menopause is associated with adverse cardiovascular changes, while surgical menopause results in a more abrupt loss of ovarian function than natural menopause. However, its early impact on subclinical left ventricular systolic function remains insufficiently defined. This study aimed to compare longitudinal changes in left ventricular global longitudinal strain (LV GLS) between women with recently confirmed natural menopause and women undergoing surgical menopause.

METHODS

This prospective observational study included 42 women with recently confirmed natural menopause and 39 perimenopausal women scheduled to undergo bilateral oophorectomy for benign gynecological indications, who subsequently constituted the surgical menopause group. In the surgical menopause group, baseline echocardiography was performed preoperatively during the perimenopausal period, whereas follow-up examinations were performed at 1 and 6 months after bilateral oophorectomy. Transthoracic echocardiography and two-dimensional speckle-tracking analysis were performed at baseline and at 1- and 6-month follow-up visits. Longitudinal changes in LV GLS were evaluated using a linear mixed-effects model adjusted for age, including time × menopause group and time × age interaction terms.

RESULTS

Women in the surgical menopause group were older than those in the natural menopause group (49.59 ± 2.36 vs. 46.07 ± 2.23 years, p < 0.001), whereas baseline left ventricular ejection fraction and LV GLS were comparable. At 1 month, LV GLS was significantly less negative in the surgical menopause group than in the natural menopause group (- 16.88 ± 1.25% vs. -17.60 ± 1.64%, p = 0.030). At 6 months, LV GLS remained numerically less negative in the surgical menopause group, but the between-group difference was not statistically significant (- 16.09 ± 1.10% vs. -16.64 ± 1.55%, p = 0.070). In the age-adjusted linear mixed-effects model, the time × surgical menopause interaction remained significant at 1 month (β = 0.50, 95% confidence interval [CI]: 0.07-0.92, p = 0.024) but not at 6 months (β = 0.18, 95% CI: -0.25 to 0.61, p = 0.400).

CONCLUSION

Surgical menopause was associated with a more pronounced early deterioration in LV GLS at 1 month after adjustment for age, despite preserved left ventricular ejection fraction. However, an independent between-group difference was not demonstrated at 6 months. LV GLS may serve as an adjunctive tool for the early cardiovascular monitoring of women undergoing surgical menopause, although its long-term prognostic value requires validation in larger studies with longer follow-up.