Abstract 1612: Improved Diastolic Function Following Marked Weight Loss in Severely Obese Women: Effects of Menopause
Background: Heart disease is relatively uncommon in women until after menopause. Many studies suggest that older women with heart failure are more likely than men to have preserved systolic function. Whether menopause affects left ventricular (LV) diastolic function is unknown.
Methods: We prospectively studied 644 severely obese female patients enrolled into a randomized trial assessing the effects of roux en Y gastric bypass surgery (GBS) on cardiovascular outcomes. At the time of enrollment into the study and 2 years later, patients underwent complete echocardiograms including Doppler assessment of early (E) and late (A) mitral inflow and tissue Doppler (TD) of the medial mitral annulus in early (E′) and late diastole (A′).
Results: At baseline, post-menopausal subjects (n=165) were older than pre-menopausal subjects (n=531; 55±7 vs. 40±10 years; p < 0.0001). BMI was similar in the 2 groups (45.2±7 vs. 45.9±7 kg/m2) while systolic blood pressure (128±19 vs. 121±16 mmHg, p<0.0001) and LV mass (179.6±45 vs 167.7±46, p=0.02) were higher in the postmenopausal group. E velocity was similar in both groups (78±18 vs. 80±16cm/s), but E deceleration time was higher (209±42* vs. 193±40ms). A velocity was higher (78±19 vs. 65±17cm/s, p<0.0001) while E/A was lower (1.03±0.3* vs. 1.3±0.4) in the postmenopausal women. When corrected for age, menopausal status was no longer associated with altered mitral inflow patterns at baseline. At 2 year follow up, both post- and pre-menopausal women lost significant amounts of weight (−38±15 vs. −45±18 kg). In the GBS group, there was a significant increase in E′ velocity and a decrease in A′ velocity measured by TD only in premenopausal women.
Conclusion: Marked weight loss following Roux en Y GBS is accompanied by favorable effects on myocardial diastolic function, but postmenopausal status may reduce these benefits.