title: Prevalence of impaired coronary flow reserve and its association with left ventricular diastolic function in asymptomatic individuals with major cardiovascular risk factors.
abstract: OBJECTIVE
  The aims of this study were to evaluate: i) the prevalence of impaired coronary flow reserve (CFR), ii) the association of impaired CFR with indices of left ventricular function, and iii) the independent predictors of impaired CFR in a cohort of high-risk asymptomatic individuals.
  
  
  METHODS
  Ninety-nine consecutive individuals (age, 52.5 ± 13.2 years; 68% male; left ventricular ejection fraction, 62 ± 6%) with at least one major cardiovascular risk factor (49% hypertension, 23% diabetes mellitus, 42% hypercholesterolemia, 32% smoking) were evaluated. Based on CFR values, patients were divided into normal (CFR ≥2.5), borderline (2.5>CFR ≥2.0), and abnormal (CFR < 2.0). Left ventricular function was assessed with comprehensive transthoracic echocardiography.
  
  
  RESULTS
  Impaired CFR was identified in 39 individuals (borderline, n = 25; abnormal, n = 14). Isovolumic relaxation time was significantly increased for abnormal compared with normal CFR (94 ± 12 vs. 85 ± 11 msec, p < 0.05), as was the left atrial volume index (LAVI) (24 ± 7 cm(3)/m(2) vs. 19.1 ± 5.2, p < 0.01). A stepwise linear regression analysis identified the LAVI and the deceleration time of E wave of transmitral flow as the only independent predictors of CFR value. An ordinal regression analysis model revealed two predictors of CFR categorization: diabetes mellitus (proportional odds ratio (POR) for CFR group deterioration, 4.55; 95% confidence interval (CI), 1.13-18.28; p = 0.033) and LAVI (POR, 1.11 per 1 cm(3)/m(2) increment; 95% CI, 1.01-1.23; p = 0.034).
  
  
  CONCLUSIONS
  CFR is often impaired among asymptomatic individuals with major cardiovascular risk factors and is associated with changes in left ventricular diastolic function and left atrial size. The prognostic importance of these early derangements should be assessed in prospective studies.
authors: Department of Cardiology, Larissa University Hospital, Larissa, Greece.
authors: George
authors: G
authors: Karayannis
authors: Gregory
authors: G
authors: Giamouzis
authors: Elias
authors: E
authors: Alexandridis
authors: Panagiotis
authors: P
authors: Kamvrogiannis
authors: Javed
authors: J
authors: Butler
authors: John
authors: J
authors: Skoularigis
authors: Filippos
authors: F
authors: Triposkiadis
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D058070:Asymptomatic Diseases; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006115:Greece / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D016277:Ventricular Function, Left