Independence of coronary artery disease to subclinical left ventricular dysfunction

Abstract

Objective: Epicardial atherosclerosis and heart failure while distinct clinical entities share common pathophysiological features including endothelial dysfunction and inflammation. Presence of subclinical disease could lead to early diagnosis and intervention in the other. The aim of our study was to assess the association between coronary calcium score (CCS), conventional cardiovascular risk factors, and echocardiographic markers of subclinical left ventricular dysfunction (S-LVD). Methods: One hundred and fifty-nine participants aged 40-70 years with intermediate risk of coronary artery disease (5-year risk of 2%-15%) were identified. Computed tomography (CT) CCS and 2-D transthoracic echocardiography were performed. Main outcomes included presence of subclinical left ventricular dysfunction defined by reduced average global longitudinal strain, left atrial volume enlargement, and elevated E/e'. Results: Fifteen participants had evidence of subclinical LV dysfunction (8 with systolic dysfunction and 7 with diastolic dysfunction) and 85 participants had CCS > 0.CCS > 0 was present in 10 participants with S-LVD compared to 75 participants without S-LVD (67% vs 53%, P = .47). There was no significant difference between in mean GLS (19.2 vs 19.5, P = .14), E/e' (7.2 vs 7.5 P = .33) in those without or with coronary artery calcium. Elevated CCS was also not associated with a higher tertiles of indexed LV mass (OR 1.15, P = .49) or index left atrial volume (OR 1.15, P = .49). Conclusions: In an asymptomatic, low-intermediate-risk group, mechanistic processes that lead to atherosclerosis are not directly associated with subclinical LV dysfunction. K E Y W O R D S coronary artery calcification, diastology, familial coronary artery disease, global longitudinal strain | 679 VENKATARAMAN ET Al.Coronary artery calcification (CAC) provides direct evidence of coronary artery disease (CAD) in the asymptomatic stage. Although there is a strong association between CAC and incident HF, only partly mitigated after adjustment for cardiovascular risk factors, 7,8 it seems likely that this reflects the contribution of overt CAD to HF.Previous studies suggesting a link between CAC and LV dysfunction were in patients with very high burdens of CAC (≥400), 9 greater severity of LV dysfunction measured by ejection fraction, 10,11 or high baseline risk, such as those with suspected CAD or known diabetes. 12,13 The role of CAD in the development of SBHF is unclear in the setting of early disease. Thus, we sought to investigate the relationship between CAC and echocardiographic markers of subclinical LV dysfunction in asymptomatic individuals. | ME THODS | Study designThe Coronary Artery calcium score: Use to Guide Management of HerediTary CAD (CAUGHT-CAD) trial (ACTRN 12614001294640, https://www.anzctr.org.au/) is a randomized controlled trial to assess the utility of coronary calcium score (CCS) to guide risk evaluation and statin therapy in asymptomatic, intermediate-risk patients (5-year risk 2%-15%) of age 40-70 years with a family hi...

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“…Moreover, researchers showed differences in age and BMI between groups with and without LVDD as opposed to our study. There were no age, gender, blood pressure, or BMI differences between population with and without LVDD, similarly to the population with low-intermediate risk of CAD [8]. Our findings which demonstrate a correlation between the presence of LVDD and LVMI are in line with the earlier studies [4,19,22].…”

“…Venkataraman [8] showed that 9.6% of participants with low-intermediate risk of coronary artery disease (CAD) had LVDD, and atherosclerosis was not directly associated with subclinical LV dysfunction. In present study, all participants had CAD, the population was older, BMI was higher and LVEF was lower compared to the above mentioned study.…”

“…They exclude situations in which an acute coronary artery thrombosis dominates the clinical presentation (which are acute coronary syndromes) [6]. CAD is commonly listed as a mechanism underlying LVDD, as myocardial ischemia may induce impaired relaxation [7], but according to recent data, stable CAD was not independently associated with LVDD [8], probably because many of the same factors contribute to atherosclerosis may also result in LVDD e.g., hypertension and vascular stiffening.…”

Diabetic microvascular complications are associated with reduced global longitudinal strain independent of atherosclerotic coronary artery disease in asymptomatic patients with diabetes mellitus: a cross-sectional study

“…A study by Scholte et al [ 8 ] showed that patients with T2DM with coronary atherosclerosis exhibited reduced GLS compared to patients with T2DM and no coronary atherosclerosis. Another study by Venkataraman et al [ 31 ] investigated the association among CAC, conventional cardiovascular risk factors and subclinical left ventricular dysfunction in patients with a low-intermediate risk of CAD. They concluded that atherosclerosis was not associated with subclinical LV dysfunction, and the findings indicated no linear relationship in a low-risk group.…”

Underlying Coronary Microvascular Disease May Lead to Underestimation of Global Longitudinal Strain Differences

“…The participants presenting with chest pain with normal coronaries on angiography and non-obstructive disease accepted as control may have microvascular coronary artery disease affecting the control GLS values, leading to underestimation of the difference between the disease and control group. Studies have shown that patients with coronary microvascular disease are known to have a significant lowering of coronary reserves, thus affecting patterns of GLS [ 2 , 3 ]. Thereby, this should be taken into consideration when interpreting the results of this study.…”