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Published on: September 22, 2023
Association of Left Ventricular Diastolic Dysfunction with Subclinical Coronary Atherosclerotic Disease Burden Using
Dimitrios Maragiannis1, Robert C Schutt, Nickalaus L Gramze
1Houston Methodist DeBakey Heart & Vascular Center.
Insights
Left ventricular diastolic dysfunction is linked to an abnormal coronary artery calcium (CAC) score, even after accounting for traditional risk factors. This suggests CAC scoring may help identify patients needing further evaluation for coronary atherosclerosis.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Diastolic dysfunction is prevalent in patients with cardiovascular risk factors like obesity, hypertension, and diabetes.
- Early detection of diastolic dysfunction is crucial for managing heart conditions.
Purpose of the Study:
- To investigate the association between left ventricular diastolic dysfunction and coronary artery calcium (CAC) scores.
- To determine if diastolic dysfunction predicts an abnormal CAC score in patients presenting with chest pain.
Main Methods:
- A cohort of 114 adult patients with normal ejection fraction and chest pain underwent myocardial perfusion imaging and cardiac CT for CAC scoring.
- Patients with prior coronary artery disease, acute coronary syndrome, or hemodynamic instability were excluded.
Main Results:
- 45.6% of patients exhibited diastolic dysfunction.
- Diastolic dysfunction was strongly associated with an abnormal CAC score (79.6% vs 20%; OR 15.10).
- This association remained significant after multivariable analysis, adjusting for clinical risk factors (OR 13.82).
Conclusions:
- Left ventricular diastolic dysfunction is an independent predictor of abnormal CAC scores.
- Patients with chest pain, normal perfusion imaging, and diastolic dysfunction may benefit from CAC score assessment.
- CAC scoring can aid in identifying individuals at higher risk for coronary atherosclerotic disease.
Aim:
Diastolic dysfunction is a common problem in patients with obesity, hypertension, diabetes, or coronary artery disease. The purpose of this study was to evaluate the association of left ventricular diastolic dysfunction with an abnormal coronary artery calcium score (CAC score).
Methods:
This study considered a cohort of patients ≥ 18 years of age with normal ejection fraction who were admitted to the hospital with chest pain. All patients underwent regadenoson myocardial perfusion stress imaging and had no evidence of ischemia or infarction. Patients then underwent cardiac CT for measurement of CAC score. Patients were excluded if they had prior history of coronary artery disease, ECG findings diagnostic of an acute coronary syndrome, an elevated troponin level, or hemodynamic instability.
Results:
A total of 114 patients were included and 52 (45.6%) patients had echocardiographic evidence of diastolic dysfunction. Patients with diastolic dysfunction were more likely to have an abnormal calcium score (79.6% vs 20%; OR 15.10, 95% CI 5.70 to 43.85; p ＜ 0.001). In multivariable analysis, the presence of diastolic dysfunction on echocardiogram was significantly associated with an abnormal calcium score (OR 13.82, 95% CI 5.57 to 37.37; p ＜ 0.001) after adjusting for Framingham Risk Score or clinical risk factors (age, gender, diabetes mellitus, dyslipidemia, and obesity; OR 19.06,95% CI 4.66 to 107.97; p ＜ 0.001).
Conclusions:
Our study demonstrates that left ventricular diastolic dysfunction is associated with an abnormal CAC score even after adjusting for Framingham Risk Score or clinical risk factors. Patients without known coronary artery disease that present with chest pain and have normal perfusion imaging with evidence of abnormal diastolic function on echocardiogram may warrant more thorough evaluation for coronary atherosclerotic disease with CAC score assessment.
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