Association Between Coronary Inflammatory Burden and Cardiac Dysfunction

Background: Heart failure is not only a mechanical impairment but also involves inflammation. This study investigated the association between quantitatively assessed coronary inflammation and cardiac dysfunction, and whether this relationship varied by coronary artery stenosis status. Methods and Results: We studied 627 patients without prior coronary artery disease (CAD) who underwent coronary computed tomography angiography and transthoracic echocardiography. Coronary inflammation was quantified using the perivascular fat attenuation index (FAI) in the proximal segments of the 3 major epicardial coronary arteries. An inflamed artery was defined as a vessel-specific FAI >75th percentile, and patients were categorized by the number of inflamed arteries (0–3). Cardiac dysfunction was defined as either systolic dysfunction (left ventricular ejection fraction [LVEF] <50%) or diastolic dysfunction (LVEF ≥50% with ≥3 abnormal guideline-based criteria). Compared with none, adjusted odds ratios (ORs) for cardiac dysfunction were 1.39 (95% confidence interval [CI] 0.70–2.78) for 1, 2.63 (95% CI 1.28–5.42) for 2, and 6.50 (95% CI 3.13–13.45) for 3 inflamed arteries. Associations were consistent in patients without obstructive CAD, with adjusted ORs for cardiac dysfunction of 1.44 (95% CI 0.66–3.16), 2.67 (95% CI 1.18–6.07), and 3.85 (95% CI 1.57–9.48), respectively. Vessel-specific analyses demonstrated similar findings. Conclusions: Greater coronary inflammatory burden was dose-dependently associated with cardiac dysfunction, even in the absence of significant coronary stenosis.