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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification
Mohamad Jihad Mansour1,2, Elie Chammas1,2, Omar Hamoui2
1Division of Cardiology, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
Insights
Diastolic dysfunction (DD) is linked to subclinical coronary artery calcification (CAC), even in younger patients. Assessing CAC may improve risk stratification in patients with normal ejection fraction and atypical symptoms.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Diastolic dysfunction (DD) assessment is crucial for heart failure patients with normal ejection fraction (EF).
- Many patients with DD remain asymptomatic, complicating early detection.
- Computed tomography calcium scoring (CTCS) is used for coronary artery disease (CAD) risk assessment.
Purpose of the Study:
- To evaluate the association between diastolic dysfunction (DD) and subclinical coronary artery calcification (CAC).
Main Methods:
- Retrospective analysis of 191 patients undergoing echocardiography and CTCS.
- DD was assessed and graded using 2D and tissue Doppler imaging.
- Coronary artery calcium (CAC) scores were quantified.
Main Results:
- 36% of patients had DD. Higher CAC scores correlated with older age, comorbidities, and DD.
- DD was independently associated with subclinical atherosclerosis (CAC > 0) (OR 3.66).
- Patients with DD, especially those under 65, showed a significant increase in subclinical coronary atherosclerosis.
Conclusions:
- Diastolic dysfunction (DD) is strongly associated with coronary artery calcification (CAC > 0), particularly in patients under 65.
- Routine CAC assessment may be warranted for risk stratification in patients with normal EF and atypical symptoms.
Background:
Assessment of diastolic dysfunction (DD) by echocardiography is an integral part of the evaluation of patients with normal ejection fraction and symptoms suggestive of heart failure. However, many patients with DD are asymptomatic. Computed tomography calcium scoring (CTCS) is often used to assess patients at low-intermediate risk for coronary artery disease (CAD). The purpose of this study was to evaluate the association of DD with subclinical coronary artery calcification.
Methods:
Consecutive patients presenting for executive checkup who underwent resting transthoracic echocardiography followed by CTCS were retrospectively identified between January 2010 and December 2014. Two-dimensional and tissue Doppler imaging parameters were analyzed for assessing and grading of DD. Coronary artery calcium (CAC) score was quantified.
Results:
A total of 191 patients (mean age 52 ± 12 years, 17% age ≥65, 20% with diabetes) were included. Of them, 69 (36%) patients had DD. Patients with higher CAC score were older, had more comorbidities, lower e', and were more likely to have DD. In the multivariate analysis, DD alone, age >65 years, or both were associated with almost threefold increase of subclinical atherosclerosis. After propensity analysis, DD was still associated with increased odds ratio (OR) for subclinical CAC (OR 3.66 [1.54-8.72], P-value .03) and similarly for e' < 10 cm/s. Compared to patients age <65 years and normal diastolic function, those age >65 years or DD had OR 3.49 (1.45-8.35) (P-value .005) for subclinical coronary atherosclerosis (CAC > 0), whereas those age >65 and DD had OR 9.30 (2.00-42) (P-value .004).
Conclusions:
Our analysis suggests that DD was strongly associated with CAC > 0, particularly among those age <65 years. Assessment of CAC as part of the routine clinical evaluation of patients with normal EF and atypical symptoms without a history of coronary atherosclerotic disease is warranted for further risk stratification.
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