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Relationship between coronary microvascular dysfunction and left ventricular diastolic function in patients with chest pain and unobstructed coronary arteries
Author(s) -
Lam Jeng Hwan,
Quah Jing Xian,
Davies Thomas,
Boos Christopher John,
Nel Karen,
Anstey Christopher M.,
Stanton Tony,
Greaves Kim
Publication year - 2020
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14794
Subject(s) - medicine , cardiology , chest pain , ejection fraction , diastole , interquartile range , univariate analysis , population , coronary arteries , heart failure , artery , blood pressure , multivariate analysis , environmental health
Backgroud Diastolic dysfunction (DD) is reported to affect up to 35% of the adult general population. The consequence of progressive DD is heart failure with preserved ejection fraction (HFpEF). Coronary microvascular dysfunction (CMD) has been suggested as one of the pathologic mechanisms leading to HFpEF. We investigated whether there was an association between coronary microvascular function and echocardiographic indices of left ventricular diastolic function at rest in patients with chest pain and unobstructed coronary arteries (CPUCA). Methods This retrospective observational study recruited patients referred to cardiology clinics assessment of chest pain who subsequently underwent assessment via CT coronary angiogram (CTA). Coronary microvascular dysfunction was determined by myocardial blood flow reserve (MBFR; <2.0) using myocardial contrast echocardiography. Echocardiographic indices of diastolic function (septal mitral annular e′; septal mitral annular E/e′, E/A ratio) were measured from baseline transthoracic echocardiogram. Results 149 patients (52% men) with a mean age 59.7(9.5) years were recruited. Mean (standard deviation) MBFR was 2.2 (0.51). 37% (55/149) had MBFR < 2.0. Median [interquartile range] septal mitral annular e′ velocity and septal mitral annular E/e′ were 7.6 cm/s [6.2, 8.9] and 9.5 [7.5, 10.8], respectively. Univariate regression analysis showed only age was a significant predictor of increasing septal mitral annular E/e′ ( β = +0.20 95% CI 0.13, +0.28, P < .001) but not MBFR. Multivariable analysis also showed no association between these septal mitral annular E/e′ and MBFR after adjustment for cardiovascular risk factors. Conclusion There was no relationship found between echocardiographic indices of left ventricular diastolic function and coronary microvascular function at rest.