Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

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.