Key result
Left ventricular diastolic dysfunction was significantly associated with an abnormal coronary artery calcium score (OR 15.10) in patients presenting with chest pain and normal perfusion imaging.
Why the study?
Is left ventricular diastolic dysfunction associated with an abnormal coronary artery calcium score in patients with normal ejection fraction and no known coronary artery disease?
Cohort (n=114)
Blinded assessors
No
Is left ventricular diastolic dysfunction associated with an abnormal coronary artery calcium score in patients with normal ejection fraction and no known coronary artery disease?
Answers are grounded in this paper and cite their sources.
May prompt CAC assessment in chest pain with diastolic dysfunction despite normal perfusion; leaves open causal links and outcome prediction.
AIM: 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.
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Maragiannis et al. (2015) conducted a cohort in Chest pain with normal ejection fraction (n=114). Left ventricular diastolic dysfunction vs. Normal diastolic function was evaluated on Abnormal coronary artery calcium score (CAC score > 0) (OR 15.10, 95% CI 5.70 to 43.85, p=<0.001). Left ventricular diastolic dysfunction was significantly associated with an abnormal coronary artery calcium score (OR 15.10) in patients presenting with chest pain and normal perfusion imaging.
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