Early Changes in Myocardial Mechanics and Diastolic Function in Women During the Menopausal Transition

Background: The menopausal transition is associated with cardiovascular remodeling, but it remains unclear whether regional alterations in left ventricular (LV) myocardial mechanics are present despite preserved global systolic function. This study investigated myocardial deformation and diastolic function in women during the menopausal transition, with particular attention to the effects of chronological age and cardiometabolic factors. Methods: This cross-sectional study included 153 women aged 45–55 years, comprising 93 perimenopausal and 60 menopausal women. Menopausal status was determined using menstrual history and hormonal assessment. Conventional echocardiography and two-dimensional speckle-tracking echocardiography were performed to assess LV structure, diastolic function, global longitudinal strain (GLS), and regional longitudinal strain. Multivariable regression models were adjusted for age, body mass index, and low-density lipoprotein cholesterol. Results: GLS was similar in menopausal and perimenopausal women (−19.62 ± 2.08% vs. −19.50 ± 1.96%; p = 0.723), whereas mean basal longitudinal strain was less negative in menopausal women (−18.14 ± 2.19% vs. −19.11 ± 2.22%; p = 0.009). This association persisted after multivariable adjustment (β = 1.07, 95% CI 0.27–1.88; p = 0.009). The largest segmental difference occurred in the basal inferior segment, which was considered an exploratory finding. Basal inferior strain was associated with LV diastolic dysfunction (OR 1.13 per 1 percentage-point shift toward less negative strain, 95% CI 1.01–1.26; p = 0.038). Its addition to the clinical model increased the apparent AUC from 0.619 to 0.667 (likelihood-ratio p = 0.035), although the difference between AUCs was not statistically significant by the paired DeLong test (p = 0.167). This finding should be considered exploratory and hypothesis-generating. Conclusions: Menopause was associated with a selective shift toward less negative basal LV longitudinal deformation and less favorable diastolic function despite preserved LVEF and GLS. In an exploratory analysis, basal inferior longitudinal strain was associated with LV diastolic dysfunction, although its apparent incremental discriminative value was modest. Regional longitudinal strain may provide complementary information on subclinical cardiac functional alterations associated with menopausal status, but its clinical utility requires validation in independent cohorts.