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Coronary microvascular dysfunction and atrial reservoir function.

Julien La Mela1, Laurent Riou2, Gilles Barone-Rochette3,4,5,6

  • 1Department of Cardiology, University Hospital, Grenoble, 38000, France.

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|May 14, 2024
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Coronary microvascular dysfunction (CMD) is linked to reduced left atrial strain (LASr), indicating early diastolic dysfunction. LASr may help identify patients with CMD and non-obstructed coronary arteries.

Keywords:
Coronary microvascular dysfunctionLeft atrial strain reservoir

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Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Diagnostic Imaging

Background:

  • Coronary microvascular dysfunction (CMD) involves abnormalities in the heart's smallest vessels, impacting diastolic function.
  • Invasive coronary physiology is used for CMD diagnosis.
  • Left atrial strain (LASr) shows promise in detecting diastolic dysfunction.

Purpose of the Study:

  • To investigate the relationship between coronary microvascular dysfunction (CMD) and left atrial strain (LASr).
  • To assess LASr as a potential noninvasive marker for early diastolic dysfunction in patients with CMD.

Main Methods:

  • Patients with non-obstructed coronary arteries (NOCA) underwent evaluation for CMD using invasive thermodilution.
  • Left atrial strain (LASr) was assessed noninvasively via echocardiography.
  • Correlation and regression analyses were performed to determine the association between CMD and LASr.

Main Results:

  • Twenty-six of 42 patients had CMD; LASr was significantly lower in patients with CMD (24.6% ± 6.1%) compared to those without (30.3% ± 7.8%).
  • A moderate correlation was found between coronary flow reserve and LASr (r=0.47, p=0.002).
  • CMD was independently associated with LASr (OR=0.88, p=0.04), with a LASr cut-off of 25.5% identifying patients with CMD.

Conclusions:

  • Patients with NOCA and CMD exhibit significantly reduced LASr.
  • Reduced LASr suggests early impairment of diastolic function in patients with CMD.
  • LASr may serve as a valuable noninvasive indicator for detecting diastolic dysfunction in CMD.