Left ventricular diastolic dysfunction as a predictor of chronic heart failure with preserved ejection fraction in perimenopausal women

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Background. This analytical review examines the development of chronic heart failure with preserved ejection fraction (CHF-pEF) in perimenopausal women. The focus is on left ventricular diastolic dysfunction (LVD) as a central pathogenetic factor and a key predictor of CHF-pEF in this population. Materials and methods. The main content includes an analysis of the pathophysiological mechanisms linking estrogen deficiency with the development of LVDD (endothelial dysfunction, RAAS activation, myocardial fibrosis, and calcium homeostasis disturbances). Epidemiological data on the high prevalence of LVDD in women during the menopausal transition are presented. Modern early diagnostic methods, primarily echocardiographic (tissue Doppler, e', E/e' indices, left atrial volume index, strain echocardiography), and their prognostic value are discussed in detail. The role of biomarkers (NT-proBNP, fibrosis markers) and complex algorithms for risk stratification are discussed. Results. The novelty of this material lies in its comprehensive and focused examination of perimenopause as a unique "window of vulnerability" for the development of LVDD, combining data on hormonal, metabolic, and cardiovascular changes. Particular attention is paid to gender-specific aspects of the pathophysiology and phenotype of cardiac remodeling; the early, often asymptomatic stages of LVDD preceding the manifestation of CHF-EF; and the potential of preclinical diagnostic approaches, including new echocardiographic technologies (strain analysis, diastolic strain rate) and biomarker panels. Conclusion. This review not only summarizes current knowledge on the relationship between menopause, LVDD, and CHF-EF but also formulates a pressing scientific and practical challenge: moving from the recognition of the high prevalence of the problem to the active search for and implementation of methods for early detection and preventive intervention in a target group of women.

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