title: Coronary endothelial dysfunction and hyperlipidemia are independently associated with diastolic dysfunction in humans.
abstract: BACKGROUND
  Coronary endothelial dysfunction (CED) and DHF are both associated with myocardial ischemia and CAD risk factors. The objective of the this study was to determine if CED and CAD factors are associated with diastolic dysfunction before the development of occlusive CAD or clinical heart failure.
  
  
  METHODS
  Patients with normal ejection fraction and nonocclusive CAD who underwent coronary endothelial function studies were identified. Left ventricular relaxation was assessed by tissue Doppler assessment of early diastolic ascent of the septal mitral annulus (Ea). Multiple linear regression was used to investigate whether coronary risk factors influenced diastolic function after adjusting for the presence of CED.
  
  
  RESULTS
  A total of 160 patients had adequate assessment of diastolic relaxation. With multiple linear regression models, %deltaCBF (P = .018) was associated with a higher Ea; in contrast, older age (P < .001), female sex (P = .028), higher left ventricular mass index (P = .016), and higher nonhigh-density lipoprotein cholesterol (P = .022) were associated with a lower Ea.
  
  
  CONCLUSIONS
  Coronary endothelial dysfunction and hyperlipidemia are independently associated with impaired relaxation in patients with normal ejection fraction in the absence of occlusive CAD and heart failure. The current study suggests a new potential mechanism for the development of endothelial and diastolic dysfunction in humans.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Elesber
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
authors.forename: Ryan
authors.initials: R
authors.lastname: Lennon
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005996:Nitroglycerin / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D018754:Ventricular Dysfunction / Q000453:epidemiology*
chemical_list: D005996:Nitroglycerin; D000109:Acetylcholine