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Relationship between Coronary Microvascular Dysfunction and Left Ventricular Diastolic Function in Patients with Chest Pain and Unobstructed Coronary Arteries
  • +5
  • Jeng Hwan Lam,
  • Jing Xian Quah,
  • Thomas Davies,
  • Christopher Boos,
  • Karen Nel,
  • Christopher Anstey,
  • Tony Stanton,
  • Kim Greaves
Jeng Hwan Lam
Sunshine Coast University Hospital
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Jing Xian Quah
Flinders Medical Centre
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Thomas Davies
Poole Hospital NHS Foundation Trust
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Christopher Boos
Poole Hospital NHS Foundation Trust
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Karen Nel
Poole Hospital NHS Foundation Trust
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Christopher Anstey
The University of Queensland Faculty of Medicine
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Tony Stanton
Sunshine Coast University Hospital
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Kim Greaves
Sunshine Coast University Hospital
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Peer review status:ACCEPTED

19 May 2020Submitted to Echocardiography
19 May 2020Submission Checks Completed
19 May 2020Assigned to Editor
19 May 2020Reviewer(s) Assigned
19 Jun 2020Review(s) Completed, Editorial Evaluation Pending
20 Jun 2020Editorial Decision: Revise Minor
25 Jun 20201st Revision Received
25 Jun 2020Submission Checks Completed
25 Jun 2020Assigned to Editor
25 Jun 2020Review(s) Completed, Editorial Evaluation Pending
26 Jun 2020Editorial Decision: Accept

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.