Diastolic dysfunction in late postmenopausal patients with undifferentiated connective tissue disease and hypertension

Aim. To assess myocardial diastolic function (DF) in late postmenopausal women with undifferentiated connective tissue disease (UCTD) and hypertension (HTN).

Material and methods. This cross-sectional study included 135 postmenopausal women, the median age of which was 68 years (65÷70,5 years). The anamnesis was collected using a standardized questionnaire. Verification of UCTD was carried out according to clinical guidelines. All patients underwent standard transthoracic echocardiography. The assessment of left ventricular (LV) DF was carried out according to the transmitral flow. LV diastolic dysfunction (DD) was classified into three types: rigid, pseudonormal, and restrictive. Statistical processing was carried out in the STATISTICA 13.0 environment. The measure of data averaging is the median, the measure of dispersion is 25%÷75%. The significance of differences was assessed using the Mann-Whitney test. Differences were considered significant at p˂0,05.

Results. Group 1 — 20 (14,8%) patients with verified UCTD and HTN, group 2 — 88 (65,2%) patients with HTN without UCTD, control group — 23 (30%) patients without HTN and UCTD. There were no differences in age, duration of postmenopause and body mass index between the groups. In the first group, a significant decrease in the ratio of peak early to late diastolic LV filling velocity was revealed (p˂0,01). A significant increase in left ventricular end-systolic wall stress revealed in group 1. In 108 (100%) patients, LVDD was detected; among the patients of the control group, DD was not detected. In 8 (40%) patients in group 1, a pseudo-normal type of DD was detected, while in 12 out of 20 patients (60%) — rigid type of DD. When assessing DF in patients of group 2, a significant decrease was found in the ratio of peak early to late diastolic LV filling velocity, a significant increase in LV end-diastolic wall stress and end-diastolic pressure. In 2 out of 3 (57,80%) patients of group 2, DD of the rigid type was detected, while pseudonormal type — in 32,2% of patients in this group. Group 2 patients had a significant decrease in the early diastolic mitral annular velocity (p˂0,01).

Conclusion. The analysis of myocardial echocardiographic characteristics indicates a significant contribution of HTN-associated UCTD to the development of LVDD in postmenopausal women.

1. Polyakov DS, Fomin IV, Belenkov YuN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. (In Russ.) doi:10.18087/cardio.2021.4.n1628.

2. Gavryushina SV, Ageev FT. Heart failure with preserved left ventricular ejection fraction: epidemiology, patient "portrait", clinic, and diagnostics. Kardiologiia. 2018;58(4S):55-64. (In Russ.). doi:10.18087/cardio.2467.

3. Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;(8):7-13. (In Russ.). doi:10.15829/1560-4071-2016-8-7-13.

4. Mareev VYu, Fomin IV, Ageev FT, et al. Clinical guidelines. Congestive heart failure. Russian Heart Failure Journal. 2017;18(1):3-40. (In Russ.). doi:10.18087/rhfj.2017.1.2346.

5. Hancock HC, Close H, Mason JM, et al. High prevalence of undetected heart failure in long-term care residents: findings from the Heart Failure in Care Homes (HFinCH) study. Eur J Heart Fail. 2013;15(2):158-65. doi:10.1093/eurjhf/hfs165.

6. Russian Society of Cardiology (RSC) (Rsc). 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.). doi:10.15829/1560-4071-2020-4083.

7. Chand V. Understanding diastolic dysfunction. JAAPA. 2006;19(3):37-46. doi:10.1097/01720610-200603000-00006.

8. Obokata M, Reddy YNV, Borlaug BA. Diastolic dysfunction and heart failure with preserved ejection fraction: understanding mechanisms by using noninvasive methods. JACC Cardiovascular imaging. 2020;13(1 Pt 2):245-57. doi:10.1016/j.jcmg.2018.12.034.

9. Anikin VV, Arsent’ev VG, Arutyunov GP, et al. Hereditary disorders of connective tissue in cardiology. Diagnosis and treatment. Russian Journal of Cardiology. 2013;(1s1):1-32. (In Russ.). doi:10.15829/1560-4071-2013-1s1.

10. Tereschenko YuV, Nechaeva GI, Potapov VV, et al. Diastolic cardiac function in connective tissue dysplasia. Lechaschi Vrach. 2019;(7):46. (In Russ.). doi:10.26295/OS.2019.68.20.009.

11. Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications. Journal of the American College of Cardiology. 2006;47:2357-63. doi:10.1016/j.jacc.2006.02.048.

12. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Journal of Echocardiography. 2016;17(12):1321-60. doi:10.1093/ehjci/jew082.

13. Balmukamedova ZhA, Zrmlyanskaya NS, Derbisalina GA. Subclinical left ventricular dysfunction in menopausal women. Bioinetgmed. 2021;6(53):36-43. (In Russ.).

14. Skali H, Shah A, Gupta DK, et al. Cardiac Structure and Function Across the Glycemic Spectrum in Elderly Men and Women Free of Prevalent Heart Disease: The Atherosclerosis Risk in the Community Study. Circ. Hear. Fail. 2015;8(3):448-54. doi:10.1161/CIRCHEARTFAILURE.114.001990.

15. Serezhina EK, Obrezan AG. The effect of sex and age hormonal changes on the development of heart failure. Russian Journal of Cardiology. 2020;25(6):3170. (In Russ.). doi:10.15829/1560-4071-2020-3710.

16. Akatova EV, Anikin VV, Arsent’ev VG, et al. Undifferentiated connective tissue dysplasia (the project of guidelines). Terapiya 2019;7(33):9-42. (In Russ.).

17. Porter TR, Mulvagh SL, Abdelmoneim SS, et al. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. Journal of the American Society of Echocardiography. 2018;31(3): 241-74. doi:10.1016/j.echo.2017.11.013.

18. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi:10.1016/j.echo.2014.10.003.

19. Kukharenko SS, Yadrikhinskaya MN, Shatskaya OA, et al. Isolated left ventricular diastolic dysfunction in diabetes mellitus: opinions change. Problems of Endocrinology. 2016;62(6):10-9. (In Russ.). doi:10.14341/probl201662610-19.

20. Izmozherova NV, Shambatov MA, Bahtin VM, et al. The role of magnesium deficiency in the pathogenesis of undifferentiated connective tissue dysplasia. Pharmateca. 2021; 13(28):63-8. (In Russ.). doi:10.18565/pharmateca.2021.13. 63-68.

21. Zelencova, LR, Kuznecov GE, Tenchurina LR. Endothelial and diastolic dysfunction among women of perimenopausal age. International Research Journal. 2022;5(119):122-7. (In Russ.). doi:10.23670/IRJ.2022.119.5.023.

22. Tsarenok SYu. Structural and functional changes of myocardium in women with osteoporosis in combination with ischemic heart disease. The Clinician. 2017;11(3-4):50-8. (In Russ.) doi:10.17650/1818-8338-2017-11-3-4-50-58.