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Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death

BACKGROUND: Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular...

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Autores principales: Hong, David, Lee, Seung Hun, Shin, Doosup, Choi, Ki Hong, Kim, Hyun Kuk, Ha, Sang Jin, Joh, Hyun Sung, Park, Taek Kyu, Yang, Jeong Hoon, Song, Young Bin, Hahn, Joo‐Yong, Choi, Seung‐Hyuk, Gwon, Hyeon‐Cheol, Lee, Joo Myung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973631/
https://www.ncbi.nlm.nih.gov/pubmed/36695307
http://dx.doi.org/10.1161/JAHA.122.027690
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author Hong, David
Lee, Seung Hun
Shin, Doosup
Choi, Ki Hong
Kim, Hyun Kuk
Ha, Sang Jin
Joh, Hyun Sung
Park, Taek Kyu
Yang, Jeong Hoon
Song, Young Bin
Hahn, Joo‐Yong
Choi, Seung‐Hyuk
Gwon, Hyeon‐Cheol
Lee, Joo Myung
author_facet Hong, David
Lee, Seung Hun
Shin, Doosup
Choi, Ki Hong
Kim, Hyun Kuk
Ha, Sang Jin
Joh, Hyun Sung
Park, Taek Kyu
Yang, Jeong Hoon
Song, Young Bin
Hahn, Joo‐Yong
Choi, Seung‐Hyuk
Gwon, Hyeon‐Cheol
Lee, Joo Myung
author_sort Hong, David
collection PubMed
description BACKGROUND: Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. METHODS AND RESULTS: A total of 330 patients without left ventricular systolic dysfunction (ejection fraction ≥50%) and significant epicardial coronary stenosis (fractional flow reserve >0.80) were analyzed. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e' velocity, tricuspid regurgitation velocity, and left atrial volume index). Overt CMD was defined as coronary flow reserve <2.0 and index of microcirculatory resistance ≥25 U. The primary end point was cardiovascular death or admission for heart failure during 5 years of follow‐up. In patients without left ventricular systolic dysfunction and significant epicardial coronary stenosis, prevalence of cardiac diastolic dysfunction and overt CMD was 25.5% and 11.2%, respectively. Overt CMD was independently associated with cardiac diastolic dysfunction (adjusted odds ratio, 3.440 [95% CI, 1.599–7.401]; P=0.002). Patients with cardiac diastolic dysfunction showed significantly higher risk of the primary outcome than those without (adjusted hazard ratio [HR], 2.996 [95% CI, 1.888–4.755]; P<0.001). Patients with overt CMD also showed significantly higher risk of the primary outcome than those without (adjusted HR, 2.939 [95% CI, 1.642–5.261]; P<0.001). Presence of overt CMD was associated with significantly increased risk of cardiovascular death among the patients with cardiac diastolic dysfunction (43.8% versus 14.5%; P=0.006) but not in patients without cardiac diastolic dysfunction (interaction P<0.001). Inclusion of overt CMD into the model with cardiac diastolic dysfunction significantly improved predictive ability for cardiovascular death or heart failure admission (conconrdance index, 0.719 versus 0.737; P for comparison=0.034). CONCLUSIONS: There was significant association between the presence of cardiac diastolic dysfunction and overt CMD. Both cardiac diastolic dysfunction and overt CMD were associated with increased risk of cardiovascular death or admission for heart failure. Integration of overt CMD into cardiac diastolic dysfunction showed improvement of the risk stratification in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. REGISTRATION: DIAST‐CMD (Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function) registry; Unique identifier: NCT05058833.
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spelling pubmed-99736312023-03-01 Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death Hong, David Lee, Seung Hun Shin, Doosup Choi, Ki Hong Kim, Hyun Kuk Ha, Sang Jin Joh, Hyun Sung Park, Taek Kyu Yang, Jeong Hoon Song, Young Bin Hahn, Joo‐Yong Choi, Seung‐Hyuk Gwon, Hyeon‐Cheol Lee, Joo Myung J Am Heart Assoc Original Research BACKGROUND: Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. METHODS AND RESULTS: A total of 330 patients without left ventricular systolic dysfunction (ejection fraction ≥50%) and significant epicardial coronary stenosis (fractional flow reserve >0.80) were analyzed. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e' velocity, tricuspid regurgitation velocity, and left atrial volume index). Overt CMD was defined as coronary flow reserve <2.0 and index of microcirculatory resistance ≥25 U. The primary end point was cardiovascular death or admission for heart failure during 5 years of follow‐up. In patients without left ventricular systolic dysfunction and significant epicardial coronary stenosis, prevalence of cardiac diastolic dysfunction and overt CMD was 25.5% and 11.2%, respectively. Overt CMD was independently associated with cardiac diastolic dysfunction (adjusted odds ratio, 3.440 [95% CI, 1.599–7.401]; P=0.002). Patients with cardiac diastolic dysfunction showed significantly higher risk of the primary outcome than those without (adjusted hazard ratio [HR], 2.996 [95% CI, 1.888–4.755]; P<0.001). Patients with overt CMD also showed significantly higher risk of the primary outcome than those without (adjusted HR, 2.939 [95% CI, 1.642–5.261]; P<0.001). Presence of overt CMD was associated with significantly increased risk of cardiovascular death among the patients with cardiac diastolic dysfunction (43.8% versus 14.5%; P=0.006) but not in patients without cardiac diastolic dysfunction (interaction P<0.001). Inclusion of overt CMD into the model with cardiac diastolic dysfunction significantly improved predictive ability for cardiovascular death or heart failure admission (conconrdance index, 0.719 versus 0.737; P for comparison=0.034). CONCLUSIONS: There was significant association between the presence of cardiac diastolic dysfunction and overt CMD. Both cardiac diastolic dysfunction and overt CMD were associated with increased risk of cardiovascular death or admission for heart failure. Integration of overt CMD into cardiac diastolic dysfunction showed improvement of the risk stratification in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. REGISTRATION: DIAST‐CMD (Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function) registry; Unique identifier: NCT05058833. John Wiley and Sons Inc. 2023-01-25 /pmc/articles/PMC9973631/ /pubmed/36695307 http://dx.doi.org/10.1161/JAHA.122.027690 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Hong, David
Lee, Seung Hun
Shin, Doosup
Choi, Ki Hong
Kim, Hyun Kuk
Ha, Sang Jin
Joh, Hyun Sung
Park, Taek Kyu
Yang, Jeong Hoon
Song, Young Bin
Hahn, Joo‐Yong
Choi, Seung‐Hyuk
Gwon, Hyeon‐Cheol
Lee, Joo Myung
Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death
title Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death
title_full Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death
title_fullStr Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death
title_full_unstemmed Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death
title_short Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death
title_sort prognostic impact of cardiac diastolic function and coronary microvascular function on cardiovascular death
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973631/
https://www.ncbi.nlm.nih.gov/pubmed/36695307
http://dx.doi.org/10.1161/JAHA.122.027690
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