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Prognostic Stratification Based on Left Ventricular Diastolic Dysfunction and Coronary Microvascular Dysfunction in

Aki Ito1, Tadashi Murai1, Hiroyuki Hikita1

  • 1Cardiovascular Center, Yokosuka Kyosai Hospital Kanagawa Japan.

Circulation Reports
|February 11, 2026
PubMed

Insights

Elevated left atrial volume index (LAVi) combined with coronary microvascular dysfunction (CMD) significantly increases the risk of major adverse cardiovascular events (MACE). This combination aids in risk stratification for patients with non-obstructive coronary artery disease.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Vascular Physiology

Background:

  • Left atrial volume index (LAVi) indicates left ventricular diastolic dysfunction (LVDD) and predicts poor outcomes.
  • Coronary microvascular dysfunction (CMD) is linked to LVDD, but their combined prognostic impact is unknown.
  • This study investigates the significance of coexisting elevated LAVi and CMD.

Purpose of the Study:

  • To evaluate the prognostic value of combined elevated LAVi and impaired coronary flow reserve (CFR).
  • To assess the risk of major adverse cardiovascular events (MACE) in patients with both conditions.

Main Methods:

  • 330 patients with suspected ischemia and non-obstructive coronary artery disease underwent intracoronary physiological assessment.
  • Patients were categorized into four groups based on LAVi and CFR.
  • Primary endpoints included cardiovascular death, acute coronary syndrome, and heart failure hospitalization.

Main Results:

  • Patients with both elevated LAVi and impaired CFR (Group 4) had significantly lower event-free survival (P<0.01).
  • A total of 16 patients experienced 18 MACE during a median follow-up of 759 days.
  • Group 4 showed a higher incidence of MACE compared to other groups.

Conclusions:

  • The coexistence of elevated LAVi and impaired CFR is associated with a significantly higher risk of MACE.
  • Combining LAVi and CFR measurements may enhance risk stratification in patients without obstructive coronary artery disease.
Abstract

Keywords:
Coronary flow reserveCoronary microvascular dysfunctionHeart failureLeft atrial volume indexLeft ventricular diastolic dysfunction

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