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Association of Diastolic Dysfunction with Angiographic Severity of Coronary Artery Disease in patients with Non-ST
J Farjana1, M A Rahman, M M Rahman
1Dr Jinat Farjana, MD, Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh;
Insights
Left ventricular diastolic dysfunction (LVDD) is linked to more severe coronary artery disease (CAD) in non-ST elevation myocardial infarction (NSTEMI) patients. This finding highlights LVDD as a marker for advanced CAD severity.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Internal Medicine
Background:
- Left ventricular diastolic dysfunction (LVDD) is an evolving clinical concern.
- LVDD presence signifies a poor prognosis in patients with acute coronary syndrome (ACS) and chronic coronary artery diseases (CAD).
- Understanding the association between LVDD and CAD severity in non-ST elevation myocardial infarction (NSTEMI) is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the association between LVDD and the angiographic severity of CAD.
- To investigate this association specifically in patients diagnosed with NSTEMI.
Main Methods:
- A cross-sectional analytical study involving 120 NSTEMI patients undergoing coronary angiography (CAG).
- Transthoracic echocardiography was performed to establish the presence or absence of LVDD.
- CAD severity was assessed using Vessel score and Leaman score.
Main Results:
- A significantly higher prevalence of positive Leaman scores (95.4%) was observed in patients with LVDD compared to those without (63.6%, p<0.001).
- Patients with LVDD showed a higher proportion of multi-vessel involvement (72.6%) compared to single-vessel involvement.
- A positive correlation was found between LVDD and CAD severity, with higher grades of diastolic dysfunction associated with more severe vessel and Leaman scores.
Conclusions:
- Left ventricular diastolic dysfunction (LVDD) is associated with angiographically severe coronary artery disease (CAD) in patients presenting with non-ST elevation myocardial infarction (NSTEMI).
- LVDD serves as an indicator of more advanced CAD, suggesting its importance in risk stratification and management of NSTEMI patients.
Abstract:
In recent years, diastolic dysfunction is an evolving context. Presence of left ventricular diastolic dysfunction (LVDD) indicates a poor prognosis in patients with an ACS and chronic coronary artery diseases. This study evaluated the association of LVDD and angiographic severity of CAD in patients with non-ST elevation myocardial infarction (NSTEMI). This cross-sectional analytical study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, during the period of April 2017 to March 2018. A total of 120 NSTEMI patients undergoing coronary angiogram (CAG) during index hospitalization were included in the study. All patients underwent transthoracic echocardiography before they underwent CAG on different days. Presence (Group I, n=65) and absence of LVDD (Group II, n=55) was established by echocardiography. Severity of CAD was assessed by Vessel score and Leaman score. Association of traditional risk factors (smoking habit, hypertension, diabetes mellitus, dyslipidemia and family history of CAD) with severity of CAD was investigated. Vessel score showed coronary artery obstruction (CAO) was present in 62(95.4%) patients in Group I and 35(63.6%) patients in Group II, single vessel was involved in 17(27.4%) patients while multi vessel in 45(72.6%) patients was found in Group I. On the contrary 27(77.1%) single vessel patients and 8(22.9%) multi vessel patients were found in Group II. Positive Leaman score was significantly higher in Group I, 62(95.4%) than that of Group II, 35(63.6%) which is statistically significant (p<0.001). This study showed a positive correlation between LVDD and CAD severity in terms of vessel score and Leamanscore. This study also demonstrates that the severity of vessel score and Leaman score was higher in the higher grade of diastolic dysfunction. The present study concludes that LVDD is associated with angiographically severe CAD in patients with NSTEMI.
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