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Published on: August 17, 2022
The Relationship of Coronary Microvascular Dysfunction and Left Ventricular Systolic and Diastolic Dysfunction: A
Qiyuan Wang1,2, Laisheng Pan3, Anxiang Sha1,2
1Department of Ultrasound, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, China.
Insights
Coronary microvascular dysfunction (CMD) is linked to reduced global longitudinal strain (GLS) and increased left atrial volume index (LAVI). These findings suggest early left ventricular (LV) involvement in CMD, even with normal ejection fraction.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Function
Background:
- Coronary microvascular dysfunction (CMD) is increasingly recognized as a key factor in myocardial ischemia and adverse cardiovascular outcomes.
- The impact of CMD on left ventricular (LV) systolic and diastolic function requires further elucidation.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing LV systolic and diastolic parameters in patients with CMD versus controls.
- To assess the association between CMD and specific echocardiographic indices of LV function.
Main Methods:
- A comprehensive search of PubMed, Embase, and Web of Science was performed for relevant observational studies.
- Pooled analyses using random-effects models were conducted for global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), LV ejection fraction (LVEF), left atrial volume index (LAVI), E/A ratio, E', and E/E'.
Main Results:
- Patients with CMD exhibited significantly lower GLS and higher LAVI compared to controls.
- No significant differences were found in GCS, GRS, or LVEF between groups.
- A trend towards higher E/E' was observed in the CMD group, but it did not reach statistical significance; substantial heterogeneity was noted for GLS and E/E'.
Conclusions:
- CMD is associated with impaired GLS and elevated LAVI, suggesting early LV involvement.
- While E/E' trended higher in CMD patients, the results require cautious interpretation due to significant heterogeneity.
- These findings support the hypothesis of early subclinical LV dysfunction in CMD, even when LVEF is preserved.
Objectives:
Coronary microvascular dysfunction (CMD) has been increasingly acknowledged as an important contributor to myocardial ischemia and unfavorable cardiovascular outcomes. However, whether CMD is associated with impairment in left ventricular (LV) systolic and diastolic function remains unclear. This systematic review and meta-analysis aimed to assess differences in LV systolic and diastolic parameters between patients with CMD and controls.
Methods:
A systematic search was conducted on PubMed, Embase, and Web of Science for observational studies reporting LV systolic and diastolic parameters in patients with CMD and controls. Pooled analyses were performed for GLS, GCS, GRS, LVEF, LAVI, E/A, E', and E/E' using random-effects models.
Results:
In total, 22 studies involving 2473 patients with CMD and 3118 controls were included. Compared with controls, the CMD group showed significantly lower GLS (MD = -0.97, p = 0.004), although substantial heterogeneity was present (I2 = 91.9%; τ2 = 1.39). No substantial differences between groups were observed for GCS, GRS, or LVEF. LAVI was markedly elevated in the CMD group (SMD = 0.19, p = 0.002), exhibiting low heterogeneity (I2 = 0.0%; τ2 = 0.00). E/E' showed a numerically higher trend in CMD patients (SMD = 0.31, 95% CI -0.02 to 0.63; p = 0.064), although this finding did not achieve statistical significance. Substantial heterogeneity was observed (I2 = 93.5%; τ2 = 0.34). No significant differences were identified in E/A or E'.
Conclusion:
CMD was associated, on average, with lower GLS and higher LAVI, whereas E/E' tended to be higher but remained non-significant, with confidence intervals including the null and considerable between-study heterogeneity. These findings may provide supportive evidence of early LV involvement in patients with CMD despite preserved LVEF, although the GLS result should be interpreted cautiously given the marked heterogeneity.
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