Relationship between Coronary Microvascular Dysfunction and Left
Ventricular Diastolic Function in Patients with Chest Pain and
Unobstructed Coronary Arteries
Abstract
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 in patients with chest pain and
unobstructed coronary arteries (CPUCA). 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’) were
measured from baseline transthoracic echocardiogram. 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’
(=+0.20 95% CI 0.13, +0.28, p<0.001) but not MBFR.
Multivariable analysis also showed no association between these septal
mitral annular E/e’ and MBFR after adjustment for cardiovascular risk
factors. There was no relationship found between echocardiographic
indices of left ventricular diastolic function and coronary
microvascular function.