Association of Left Ventricular Diastolic Dysfunction with Subclinical Coronary Atherosclerotic Disease Burden Using Coronary Artery Calcium Scoring.
OBJECTIVE
Diastolic dysfunction is a common problem in patients with obesity, hypertension, diabetes, or coronary artery disease. The purpose of this study was to evaluate the association of left ventricular diastolic dysfunction with an abnormal coronary artery calcium score (CAC score).


METHODS
This study considered a cohort of patients ≥ 18 years of age with normal ejection fraction who were admitted to the hospital with chest pain. All patients underwent regadenoson myocardial perfusion stress imaging and had no evidence of ischemia or infarction. Patients then underwent cardiac CT for measurement of CAC score. Patients were excluded if they had prior history of coronary artery disease, ECG findings diagnostic of an acute coronary syndrome, an elevated troponin level, or hemodynamic instability.


RESULTS
A total of 114 patients were included and 52 (45.6%) patients had echocardiographic evidence of diastolic dysfunction. Patients with diastolic dysfunction were more likely to have an abnormal calcium score (79.6% vs 20%; OR 15.10, 95% CI 5.70 to 43.85; p ＜ 0.001). In multivariable analysis, the presence of diastolic dysfunction on echocardiogram was significantly associated with an abnormal calcium score (OR 13.82, 95% CI 5.57 to 37.37; p ＜ 0.001) after adjusting for Framingham Risk Score or clinical risk factors (age, gender, diabetes mellitus, dyslipidemia, and obesity; OR 19.06,95% CI 4.66 to 107.97; p ＜ 0.001).


CONCLUSIONS
Our study demonstrates that left ventricular diastolic dysfunction is associated with an abnormal CAC score even after adjusting for Framingham Risk Score or clinical risk factors. Patients without known coronary artery disease that present with chest pain and have normal perfusion imaging with evidence of abnormal diastolic function on echocardiogram may warrant more thorough evaluation for coronary atherosclerotic disease with CAC score assessment.
Houston Methodist DeBakey Heart & Vascular Center.
Dimitrios
D
Maragiannis
Robert C
RC
Schutt
Nickalaus L
NL
Gramze
Kongkiat
K
Chaikriangkrai
Kelly
K
McGregor
Karen
K
Chin
Faisal
F
Nabi
Stephen H
SH
Little
Sherif F
SF
Nagueh
Su Min
SM
Chang
D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D002114:Calcinosis / Q000097:blood*; D002118:Calcium / Q000378:metabolism; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014336:Troponin / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*
D014336:Troponin; D002118:Calcium