Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : OC24 - OC27 Full Version

Echocardiographic Evaluation of Diastolic Dysfunction among Menopausal Women: A Cross-sectional Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58660.17137
E Thirumurugan, K Gomathi, P Swathy, Syed Ali Afrin, H Sriram, F Aathilakshmi, S Kalimunnisha, A Yamuna

1. Research Scholar, Srinivas University, India, and Lecturer, Faculty of Allied Health Science, Dr. M.G.R. Educational and Research Institute, Chennai, Tamil Nadu, India. 2. Tutor, Faculty of Allied Health Science, Dr. M.G.R. Educational and Research Institute, Vanagram, Chennai, Tamil Nadu, India. 3. Lecturer, Department of Cardiology, Dr. M.G.R. Educational and Research Institute, Vanagram, Chennai, Tamil Nadu, India. 4. Tutor, Faculty of Allied Health Science, Dr. M.G.R. Educational and Research Institute, Vanagram, Chennai, Tamil Nadu, India. 5. Intern, Faculty of Allied Health Science, Dr. M.G.R. Educational and Research Institute, Vanagram, Chennai, Tamil Nadu, India. 6. Intern, Department of Cardiology, Dr. M.G.R. Educational and Research Institute, Vanagram, Chennai, Tamil Nadu, India. 7. Intern, Department of Cardiology, Dr. M.G.R. Educational and Research Institute, Vanagram, Chennai, Tamil Nadu, India. 8. Intern, Faculty of Allied Health Science, Dr. M.G.R. Education

Correspondence Address :
Dr. E Thirumurugan,
1/222, Perumalkovil Street, Vanagram, Mettukupam, Vanagram,
Chennai, Tamil Nadu, India.
E-mail: thirumurugan.cct@drmgrdu.ac.in

Abstract

Introduction: Heart Failure with Normal Ejection Fraction (HFNEF), also known as Diastolic Heart Failure (DHF), has been well-studied since the past two decades. The signs of HFNEF are signs of heart failure and abnormal ventricular filling pressure with normal systolic function. A Metabolic Syndrome (MS) is a clustering of metabolic risk factors. Cardiovascular disease caused by metabolic syndrome includes vascular and myocardial abnormalities such as diastolic dysfunction and relaxation abnormalities.

Aim: To study the assosciation between the timing of menopause and Left Ventricular Diastolic Dysfunction (LVDD) in those with and without MS.

Materials and Methods: This cross-sectional study was conducted in the period between December 2021 to June 2022 at the Department of Cardiology in A.C.S Medical College and Hospital, Chennai, Tamil Nadu, India. All female patients that underwent a medical examination were selected for the study. Postmenopausal women without overt heart diseases (such as a history of heart valve disease or myocardial infarction, or a prior LV ejection fraction >50%) were included. The present study included 80 patients grouped into two: those with and without MS. The MS group included 30 subjects, divided into two subgroups: those who experienced menopause at or before 50 years of age (early menopause group) and those who experienced menopause at or after 50 years of age (late menopause group). Out of 80, 50 participants were divided into early menopause and late menopause groups among women without MS. The present study analyse the evolution of LVDD, assessed by transthoracic echocardiography (TTE), in 80 postmenopausal women with and without MS. Independent t-tests was applied to assess the association between the timing of menopause and LVDD.

Results: The mean age was 60±7.3 years in women with MS and 62±8.8 years in women without MS. There were no significant differences in the duration, since menopause between the postmenopausal women with and without MS. No significant difference was found between the two groups (early vs late menopause group) with respect to any diastolic parameter, including Early (E) and Late (A), E/A ratio, and E/e in women with MS. In postmenopausal women without MS, there was a significant difference in diastolic parameters including the A, early diastolic annular velocity (e’), ratio of early diastolic transmitral flow velocity to annular flow velocity was calculated (E/e’) between the two groups (early vs late menopause group). In comparison to patients with MS, patients without the condition had significantly lower early peak mitral inflow velocity (E, p-value=0.019), early diastolic mitral annulus motion velocity (e’-septal, p-value=0.05), late peak mitral inflow velocity ratio (E/A, p-value=0.07), and LV filling pressure values (E/e, p-value=0.02).

Conclusion: Early menopause impacts diastolic function in postmenopausal women and LVDD progression in women without MS. LVDD progression in women with MS was unaffected by early menopause.

Keywords

Diastolic heart failure, Early menopause, Late menopause, Metabolic syndrome, Postmenopausal women

Due to the stiffening of cardiac muscles, Diastolic Heart Failure (DHF) is characterised by a reduction in the volume of the ventricles and an inability to relax them. Age, gender, hypertension, diabetes mellitus, and cardiomyopathy contribute to a greater prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF). The risk of cardiovascular disease associated with hypertension rises sharply with age. Clinically, the diastolic function of the LV may be defined as its capacity to receive LV filling volume with sufficient stroke volume. Heart failure with normal ejection fraction (HFNEF), also called DHF, has become increasingly well-known over the last two decades. The clinical features of HFNEF include symptoms of heart failure and signs of elevated ventricular filling pressure and impaired relaxation in spite of normal systolic function (1). The Helsinki’s Ageing study showed that DHF is common in older adults. DHF was present in 50% of patients with clinical heart failure aged 75-86 years. However, a definitive diagnosis is still elusive (2). The risk of DHF is higher in women than in men, particularly in postmenopausal women (3). The diastolic function of the LV was found to be significantly reduced in women after 50-60 years of age compared to men, suggesting that menopause leads to the condition (4). The mechanisms of oestrogen’s cardioprotective effects have been extensively studied. Through the renin-angiotensin system, oestrogen regulates gene expression, sympathetic tone, and heart function (5),(6). The natural cessation of menstruation that occurs during menopause is accompanied by a sharp drop in ovarian hormone production, particularly oestrogen. Oestrogen has a cardioprotective effect. The loss of oestrogen’s cardioprotective function after menopause may be a major factor in the progression of LVDD in elderly women (7). LVDD and age at menopause (early or late) have been studied in healthy postmenopausal women (8). Menopausal age (early or late) may influence the development of LVDD in postmenopausal women (9). The present study was undertaken to assess the association between the timing of menopause and LVDD in those with and without MS, with the hypothesis that women who experienced early menopause may have more advanced LVDD due to the loss of oestrogen’s cardioprotective effect.

Material and Methods

The cross-sectional study was conducted in the Department of Cardiology at ACS Medical College and Hospital, Chennai, Tamil Nadu, India, from December 2021 to June 2022. Written informed consent was obtained from each participant before the commencement of the study. The study was approved by the Institutional Ethical Committee (No.474/2022/IEC/ACSMCH).

Inclusion criteria: Postmenopausal women without overt heart diseases (such as a history of heart valve disease or myocardial infarction, or a prior LV ejection fraction >50%) were included in the study.

Exclusion criteria: Patients with an LV ejection fraction of less than 50%, atrial fibrillation, and poor echocardiography were excluded from the study.

Sample size calculation: The sample size was calculated based on the following formula (10)

n= 2(Z1-α/2+Z1-β)2α2/d2

Z1-α/2=2.24 (5% Level of significance after Bone ferroni correction for 4 comparsions)
Z1-β=0.84 (for 80% power valve ), α=2.5( SD)
d=2 (expected clinically significant difference between any two comparison)

n= 2(2.24+0.84)2(2.5)2/22= 30 (Pregroup)=60 (Total)

The final sample size calculated was 60.

Study Procedure

The present study included 80 patients grouped into two: those with and without MS. The MS group included 30 subjects divided into two subgroups: those who experienced menopause at or before 50 years of age (early menopause group) and those who experienced menopause at or after 50 years of age (late menopause group). Out of total, 50 participants were divided into early menopause and late menopause groups among women without MS.

A complete clinical assessment was conducted, including height, weight, diastolic and systolic blood pressure measurements, heart rate, and Basal Metabolic Index (BMI). Furthermore, the subjects were asked when they experienced menopause as the natural cessation of bleeding, as well as the duration after menopause. Additionally, a questionnaire was used to obtain information concerning the subjects’ pregnancy status, delivery history, treatment of hypertension, diabetes, dyslipidaemia, and smoking status.

An echocardiographic examination was conducted using commercially available equipment (E95, Phillips) and included both two-dimensional and Doppler imaging. Two-dimensional echocardiography was performed to quantify the left atrial and left ventricular chambers following the guidelines of the American Society of Echocardiography (ASE). The Teichholz formula was used to calculate the LV ejection fraction. The mitral annular motion at the septum was measured using tissue Doppler imaging. An apical four-chamber view of pulsed wave Doppler imaging measured the peak velocity of Early (E) and Late (A) diastolic flow and the deceleration time of early diastolic flow. Using tissue Doppler imaging, early diastolic annular velocity (e’) was measured at the septum in an apical four-chamber view. The ratio of early diastolic transmitral flow velocity to annular flow velocity was calculated (E/e’). The diastolic function of all subjects was also classified into four categories (normal, grade I, grade II, or grade III) (11).

Statistical Analysis

Statistical Package for the Social Science (SPSS) software was used for the statistical analysis. The descriptive variables are presented as means and standard deviations. Independent t-tests were performed to compare echocardiographic parameters (peak E, peak A, E/A, e’, E/e’, and DCT) between the two groups. A p-value of less than 0.05 was considered significant.

Results

In the present study, 80 patients were enrolled into two categories: postmenopausal women with and without MS. The mean age was 60±7.3 years in women with MS and 62±8.8 years in women without MS. There were no significant differences in the duration since menopause, between the postmenopausal women with and without MS (Table/Fig 1).

In postmenopausal women without MS, there was a significant difference in diastolic parameters including the A, e’, E/e’ between the two groups (early vs late menopause group) (Table/Fig 2).

The echocardiographic parameters of the two groups (early vs late) were compared in the MS group, as shown in (Table/Fig 3). No significant difference was found between any diastolic parameter. Despite a large difference in e’ between the two groups (p-value=0.04), e’ was higher in the late menopause group than in the early menopause group.

The echocardiographic parameters of the two groups (women with and without MS) are compared in (Table/Fig 4). In comparison to patients with MS, patients without the condition had significantly lower early peak mitral inflow velocity (E, p-value=0.019), early diastolic mitral annulus motion velocity (e’-septal, p-value=0.05), late peak mitral inflow velocity ratio (E/A, p-value= 0.07), and LV filling pressure values (E/e, p-value=0.02).

Discussion

In postmenopausal women, oestrogen secretion decreases as a result of metabolic changes and the accumulation of abdominal fat. It is important to lower postmenopausal women’s risk of cardiovascular disease. It implies that among postmenopausal women, monitoring blood sugar, blood pressure, and lipid profiles as well as altering their lifestyle can result in weight loss by diet (12). The progression of LVDD has been demonstrated to expose patients to a high risk of developing future DHF, which is associated with ageing even in a healthy population (13). Even though there is a strong association between a high prevalence of DHF and an increased progression of LVDD in older women, the underlying pathogenesis is unclear. Literature has examined the mechanism underlying the cardioprotective effects of oestrogen (14),(15). Through the renin-angiotensin system, oestrogen regulates gene expression, sympathetic tone, and heart function (5),(6).

According to a recent study by Rahman I et al. (16), the age of natural menopause and the risk of HF are significantly related. However, the study did not evaluate LV diastolic function. The mean age or early menopause cutoff of the current study was similar to that in the Hirokawa M et al. study of 115 elderly women patients and found that LVDD progression was not influenced by early menopause in healthy postmenopausal women (8). According to the present study hypothesis, early menopausal women would incur an advanced LVDD. The present study provides evidence that early menopause impacts postmenopausal women’s LV diastolic function and LVDD progression in patients without metabolic syndrome.

Chung JW et al. studied 190 women and found that the MS group had a significantly lower mean E, E’, and E/A ratios than the normal group (17). This study provides evidence that the women without metabolic syndrome had a significantly lower early peak mitral inflow velocity (E, p-value=0.019), early diastolic mitral annulus motion velocity (e’-septal, p-value=0.05), late peak mitral inflow velocity ratio (E/A, p-value=0.07), and LV filling pressure values (E/e, p-value=0.02) than those with metabolic syndrome.

The pathophysiological mechanism underlying the rapid progression of LVDD in older women is likely multifactorial and not mainly influenced by the loss of oestrogen’s cardioprotective effects (18). Increased LV afterload produced by higher blood pressure and vascular tone is linked to the occurrence of LVDD (20). LVDD is exacerbated by an increase in body weight and alterations to the body’s fat distribution (19). Further study is necessary to overcome these challenges.

Limitation(s)

The study was conducted in a single centre. Diabetes and hypertension are risk factors for DHF, and may have an effect on LV diastolic function, which could influence study findings further.

Conclusion

According to the results of the present study, menopause, particularly early menopause, impacts diastolic function and LVDD progression in women without metabolic syndrome. On the other hand, the present study shows that early menopause had no impact on the progression of LVDD in women with metabolic syndrome. Consequently, women with MS experiences diastolic dysfunction more than women without it.

Acknowledgement

Researchers thankfully acknowledge Dr. Kalpana Devi, Principal, and Dr. Kalavathy Victor, Director of Allied Health Science of Dr. M.G.R. Educational and Research Institute for active guidance throughout the study.

References

1.
Germing A, Gotzmann M, Schikowski T, Vierkötter A, Ranft U, Krämer U, et al. High frequency of diastolic dysfunction in a population-based cohort of elderly women-but poor association with the symptom dyspnea. BMC Geriatrics. 2011;11(1):71. [crossref] [PubMed]
2.
O’Mahony MS, Sim MFV, Ho SF, Steward JA, Buchalter M, Burr M. Diastolic heart failure in older people. Age Ageing. 2003;32(5):519-24. [crossref] [PubMed]
3.
Bozkurt B, Khalaf S. Heart failure in women. Methodist Debakey Cardiovasc J. 2017;13(4):216-23. [crossref] [PubMed]
4.
Maslov PZ, Kim JK, Argulian E, Ahmadi A, Narula N, Singh M, et al. Is cardiac diastolic dysfunction a part of post-menopausal syndrome? JACC Heart Fail. 2019;7(3):192-03. [crossref] [PubMed]
5.
Murphy E, Steenbergen C. Estrogen regulation of protein expression and signaling pathways in the heart. Biol Sex Differ. 2014;5(1):06. [crossref] [PubMed]
6.
Groban L, Yamaleyeva LM, Westwood BM, Houle TT, Lin M, Kitzman DW, et al. Progressive diastolic dysfunction in the female mRen(2). Lewis rat: Influence of salt and ovarian hormones. J Gerontol A Biol Sci Med Sci. 2008;63(1):03-11. [crossref] [PubMed]
7.
Zhao Z, Wang H, Jessup JA, Lindsey SH, Chappell MC, Groban L. Role of estrogen in diastolic dysfunction. Am J Physiol Heart Circ Physiol. 2014;306(5):H628-40. [crossref] [PubMed]
8.
Hirokawa M, Daimon M, Lee SL, Nakao T, Kawata T, Kimura K, et al. Early menopause does not influence left ventricular diastolic dysfunction: A clinical observational study in healthy subjects. J Cardiol. 2016;68(6):548-53. [crossref] [PubMed]
9.
Wang H, Jessup JA, Lin MS, Chagas C, Lindsey SH, Groban L. Activation of GPR30 attenuates diastolic dysfunction and left ventricle remodelling in oophorectomized mRen2.Lewis rats. Cardiovasc Res. 2012;94(1):96-04. [crossref] [PubMed]
10.
Daniel WW, editor. Biostatistics: A foundation for analysis in the health sciences. 7th ed. New York: John Wiley & Sons; 1999.
11.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107-33. [crossref] [PubMed]
12.
Heidari R, Sadeghi M, Talaei M, Rabiei K, Mohammadifard N, Sarrafzadegan N. Metabolic syndrome in menopausal transition: Isfahan healthy heart program. A population based study. Diabetol Metab Syndr. 2010;2(1):59. [crossref] [PubMed]
13.
Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening. Circulation. 2005;112(15):2254-62. [crossref] [PubMed]
14.
Mori T, Kai H, Kajimoto H, Koga M, Kudo H, Takayama N, et al. Enhanced cardiac inflammation and fibrosis in ovariectomized hypertensive rats: A possible mechanism of diastolic dysfunction in postmenopausal women. Hypertens Res. 2011;34(4):496-02. [crossref] [PubMed]
15.
Maric-Bilkan C, Gilbert EL, Ryan MJ. Impact of ovarian function on cardiovascular health in women: Focus on hypertension. Int J Womens Health. 2014;6:131-39. [crossref] [PubMed]
16.
Rahman I, Åkesson A, Wolk A. Relationship between age at natural menopause and risk of heart failure. Menopause. 2015;22(1):12-16. [crossref] [PubMed]
17.
Chung JW, Seo DI, Park Y, So WY. Echocardiography evaluation of left ventricular diastolic function in elderly women with metabolic syndrome. Open Med (Wars). 2019;14(1):633-38. [crossref] [PubMed]
18.
Barrett-Connor E. Menopause, atherosclerosis, and coronary artery disease. Curr Opin Pharmacol. 2013;13(2):186-91. [crossref] [PubMed]
19.
Schillaci G, Pasqualini L, Verdecchia P, Vaudo G, Marchesi S, Porcellati C, et al. Prognostic significance of left ventricular diastolic dysfunction in essential hypertension. J Am Coll Cardiol. 2002;39(12):2005-11. [crossref] [PubMed]
20.
Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, et al. Effect of obesity and overweight on left ventricular diastolic function. J Am Coll Cardiol. 2011;57(12):1368-74. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/58660.17137

Date of Submission: Jun 24, 2022
Date of Peer Review: Sep 01, 2022
Date of Acceptance: Sep 19, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 28, 2022
• Manual Googling: Sep 09, 2022
• iThenticate Software: Sep 16, 2022 (14%)

ETYMOLOGY: Author Origin

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