title: Extent and severity of coronary artery disease by coronary CT angiography is associated with elevated left ventricular diastolic pressures and worsening diastolic function.
abstract: BACKGROUND
  Patients with flow-limiting coronary stenoses exhibit elevated left ventricular end-diastolic pressure (LVEDP) and abnormal left ventricular (LV) relaxation.
  
  
  OBJECTIVE
  We investigated the relationship of extent and severity of coronary artery disease (CAD) by coronary CT angiography (CTA) to LVEDP and measures of LV diastolic dysfunction.
  
  
  METHODS
  We identified consecutive patients undergoing coronary CTA and transthoracic echocardiography who were assessed for diastolic function. CAD was evaluated on a per-patient, per-vessel, and per-segment basis for intraluminal diameter stenosis by using an 18-segment model (0 = none, 1 = 1%-49%, 2 = 50%-69%, and 3 = 70%-100%) and summed over segments to obtain overall coronary plaque burden (segment stenosis score [SSS]; maximum = 54). Transthoracic echocardiography evaluated mitral inflow E wave-to-A wave ratio, tissue Doppler early mitral annual tissue velocity axial excursion, stage of diastolic dysfunction, and LV dimensions and estimated LVEDP from the ratio of mitral inflow velocity to early mitral annular (medial) tissue velocity.
  
  
  RESULTS
  Four hundred seventy-eight patients (57% women; mean age, 57.9 ± 14.6 years; 24.9% prior CAD) comprised the study population. Increasing per-patient maximal coronary stenosis, number of vessels with obstructive stenosis, and SSS were associated with increased LVEDP. The prevalence of advanced diastolic dysfunction increased with greater number of obstructive vessels. In multivariable analyses, SSS was associated with increased LVEDP (0.8 mm Hg per tertile increase in SSS, 0.5-1.1; P < .001); reduced E' axial excursion (-0.3; 95% confidence interval [CI], -0.5 to -0.1; P = .001), increased LV mass index (1.6 g/m(2) per tertile increase in SSS; P = .04), and increased relative wall thickness (0.005; 95% CI, 0.004-0.009; P = .03), with consistent relationships persisting even among persons with per-patient maximal stenosis <50% and LV ejection fraction ≥ 55%.
  
  
  CONCLUSIONS
  Extent and severity of obstructive as well as nonobstructive CAD by coronary CTA are associated with increased LVEDP and measures of diastolic dysfunction.
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, Starr 415, 525 E 68th St, New York, NY 10065, USA; Division of Radiology, Weill-Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. Electronic address: fal9003@med.cornell.edu.
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Micheas
authors.initials: M
authors.lastname: Zemedkun
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.forename: Millie
authors.initials: M
authors.lastname: Gomez
authors.forename: Troy M
authors.initials: TM
authors.lastname: Labounty
authors.forename: Muhammad
authors.initials: M
authors.lastname: Asim
authors.forename: Evelyn
authors.initials: E
authors.lastname: Horn
authors.forename: Gerard
authors.initials: G
authors.lastname: Aurigemma
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Maurer
authors.forename: Mary
authors.initials: M
authors.lastname: Roman
authors.forename: Richard
authors.initials: R
authors.lastname: Devereux
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008955:Models, Cardiovascular; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012720:Severity of Illness Index; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left
keywords: Computed tomography; Coronary artery disease; Diastolic dysfunction; Echocardiography; Left ventricular hypertrophy