Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

Abstract

Background Assessment of diastolic dysfunction (DD) by echocardiography is an integral part of the evaluation of patients with normal ejection fraction and symptoms suggestive of heart failure. However, many patients with DD are asymptomatic. Computed tomography calcium scoring (CTCS) is often used to assess patients at low‐intermediate risk for coronary artery disease (CAD). The purpose of this study was to evaluate the association of DD with subclinical coronary artery calcification. Methods Consecutive patients presenting for executive checkup who underwent resting transthoracic echocardiography followed by CTCS were retrospectively identified between January 2010 and December 2014. Two‐dimensional and tissue Doppler imaging parameters were analyzed for assessing and grading of DD. Coronary artery calcium (CAC) score was quantified. Results A total of 191 patients (mean age 52 ± 12 years, 17% age ≥65, 20% with diabetes) were included. Of them, 69 (36%) patients had DD. Patients with higher CAC score were older, had more comorbidities, lower e′, and were more likely to have DD. In the multivariate analysis, DD alone, age >65 years, or both were associated with almost threefold increase of subclinical atherosclerosis. After propensity analysis, DD was still associated with increased odds ratio (OR) for subclinical CAC (OR 3.66 [1.54‐8.72], P‐value .03) and similarly for e′ < 10 cm/s. Compared to patients age <65 years and normal diastolic function, those age >65 years or DD had OR 3.49 (1.45‐8.35) (P‐value .005) for subclinical coronary atherosclerosis (CAC > 0), whereas those age >65 and DD had OR 9.30 (2.00‐42) (P‐value .004). Conclusions Our analysis suggests that DD was strongly associated with CAC > 0, particularly among those age <65 years. Assessment of CAC as part of the routine clinical evaluation of patients with normal EF and atypical symptoms without a history of coronary atherosclerotic disease is warranted for further risk stratification.

Heart Failure in Lebanon: A Review of the Literature

“…All the studies were conducted in the capital city of Beirut, with the exception of one study conducted in the North Lebanese (Kossaify & Nicolas, 2013). Nine of the eleven studies were descriptive, four used a retrospective chart review design (Abou Dagher et al, 2018;Deek & Skouri et al, 2016;Mansour et al, 2020;Moukarbel & Arnaout, 2003), and two studies used a randomized controlled intervention design (Deek et al, 2017;Sadek et al, 2020). Two studies measured self-care in patients living with HF (Deek et al, 2017;Massouh et al, 2020).…”

“…Three studies addressed diastolic dysfunction. Mansour et al (2020) studied the link between diastolic dysfunction and coronary artery calcium scoring, whereas another study addressed the effect of physical inactivity on diastolic dysfunction (Matta et al, 2016). One study adressed the effect of body mass index and waist circumference on diastolic dysfunction (Kossaify & Nicolas, 2013).…”

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2020: positron emission tomography, computed tomography, and magnetic resonance

“… 12 , 13 Coronary artery calcifications are easily detected on cardiac CT, on CT attenuation correction used with PET imaging, CT chest, and others, and correlate with early myocardial dysfunction. 14 Similarly, calcifications of non-coronary artery vasculature are equally important since atherogenesis is a systemic process that involves all arterial beds. For instance, calcifications of breast arteries seen on mammogram correlate well with coronary artery calcification and predict mortality.…”

Comprehensive assessment of systemic arteriosclerosis in relation to the ocular resistive index in acute coronary syndrome patients

“…HFpEF increases the left ventricular and systemic arterial stiffness, and promotes diastolic dysfunction 8 . Diastolic dysfunction was associated with coronary artery calcium score, indicating an association with atherosclerosis 9 . Moreover, it has been reported that transient retinopathy (soft exudate) occurred in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), suggesting that ACS might be involved in ocular circulation impairment 10 , 11 .…”