J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 2 8 9 e2 9 6
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Original Research Article
Extent and severity of coronary artery disease by coronary CT angiography is associated with elevated left ventricular diastolic pressures and worsening diastolic function Fay Y. Lin MDa,b,*, Micheas Zemedkun MDa, Allison Dunning MSa, Millie Gomez MDb, Troy M. Labounty MDc, Muhammad Asim MDa, Evelyn Horn MDa, Gerard Aurigemma MDd, Matthew S. Maurer MDe, Mary Roman MDa, Richard Devereux MDa, James K. Min MDa a
Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, Starr 415, 525 E 68th St, New York, NY 10065, USA b Division of Radiology, Weill-Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA c Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA d Department of Cardiology, University of Massachusetts, Worcester, MA, USA e Department of Cardiology, Columbia University Medical Center, New York, NY, USA
article info
abstract
Article history:
Background: Patients with flow-limiting coronary stenoses exhibit elevated left ventricular
Received 30 January 2013
end-diastolic pressure (LVEDP) and abnormal left ventricular (LV) relaxation.
Received in revised form
Objective: We investigated the relationship of extent and severity of coronary artery disease
22 July 2013
(CAD) by coronary CT angiography (CTA) to LVEDP and measures of LV diastolic
Accepted 16 August 2013
dysfunction. Methods: We identified consecutive patients undergoing coronary CTA and transthoracic
Keywords:
echocardiography who were assessed for diastolic function. CAD was evaluated on a per-
Computed tomography
patient, per-vessel, and per-segment basis for intraluminal diameter stenosis by using an
Coronary artery disease
18-segment model (0 ¼ none, 1 ¼ 1%e49%, 2 ¼ 50%e69%, and 3 ¼ 70%e100%) and summed
Diastolic dysfunction
over segments to obtain overall coronary plaque burden (segment stenosis score [SSS];
Left ventricular hypertrophy
maximum ¼ 54). Transthoracic echocardiography evaluated mitral inflow E wave-to-A
Echocardiography
wave ratio, tissue Doppler early mitral annual tissue velocity axial excursion, stage of diastolic dysfunction, and LV dimensions and estimated LVEDP from the ratio of mitral inflow velocity to early mitral annular (medial) tissue velocity. Results: Four hundred seventy-eight patients (57% women; mean age, 57.9 14.6 years; 24.9% prior CAD) comprised the study population. Increasing per-patient maximal coronary stenosis, number of vessels with obstructive stenosis, and SSS were associated with increased LVEDP. The prevalence of advanced diastolic dysfunction increased with greater
Conflict of interest: Dr Min receives research support from Vital Images, serves on the speaker’s bureau, and is a consultant to GE Healthcare. The rest of the authors report no conflict of interest. * Corresponding author. E-mail address: [email protected] (F.Y. Lin). 1934-5925/$ e see front matter ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2013.08.008
290
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 2 8 9 e2 9 6
number of obstructive vessels. In multivariable analyses, SSS was associated with increased LVEDP (0.8 mm Hg per tertile increase in SSS, 0.5e1.1; P < .001); reduced E0 axial excursion (0.3; 95% confidence interval [CI], 0.5 to 0.1; P ¼ .001), increased LV mass index (1.6 g/m2 per tertile increase in SSS; P ¼ .04), and increased relative wall thickness (0.005; 95% CI, 0.004e0.009; P ¼ .03), with consistent relationships persisting even among persons with per-patient maximal stenosis
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Original Research Article
Extent and severity of coronary artery disease by coronary CT angiography is associated with elevated left ventricular diastolic pressures and worsening diastolic function Fay Y. Lin MDa,b,*, Micheas Zemedkun MDa, Allison Dunning MSa, Millie Gomez MDb, Troy M. Labounty MDc, Muhammad Asim MDa, Evelyn Horn MDa, Gerard Aurigemma MDd, Matthew S. Maurer MDe, Mary Roman MDa, Richard Devereux MDa, James K. Min MDa a
Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, Starr 415, 525 E 68th St, New York, NY 10065, USA b Division of Radiology, Weill-Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA c Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA d Department of Cardiology, University of Massachusetts, Worcester, MA, USA e Department of Cardiology, Columbia University Medical Center, New York, NY, USA
article info
abstract
Article history:
Background: Patients with flow-limiting coronary stenoses exhibit elevated left ventricular
Received 30 January 2013
end-diastolic pressure (LVEDP) and abnormal left ventricular (LV) relaxation.
Received in revised form
Objective: We investigated the relationship of extent and severity of coronary artery disease
22 July 2013
(CAD) by coronary CT angiography (CTA) to LVEDP and measures of LV diastolic
Accepted 16 August 2013
dysfunction. Methods: We identified consecutive patients undergoing coronary CTA and transthoracic
Keywords:
echocardiography who were assessed for diastolic function. CAD was evaluated on a per-
Computed tomography
patient, per-vessel, and per-segment basis for intraluminal diameter stenosis by using an
Coronary artery disease
18-segment model (0 ¼ none, 1 ¼ 1%e49%, 2 ¼ 50%e69%, and 3 ¼ 70%e100%) and summed
Diastolic dysfunction
over segments to obtain overall coronary plaque burden (segment stenosis score [SSS];
Left ventricular hypertrophy
maximum ¼ 54). Transthoracic echocardiography evaluated mitral inflow E wave-to-A
Echocardiography
wave ratio, tissue Doppler early mitral annual tissue velocity axial excursion, stage of diastolic dysfunction, and LV dimensions and estimated LVEDP from the ratio of mitral inflow velocity to early mitral annular (medial) tissue velocity. Results: Four hundred seventy-eight patients (57% women; mean age, 57.9 14.6 years; 24.9% prior CAD) comprised the study population. Increasing per-patient maximal coronary stenosis, number of vessels with obstructive stenosis, and SSS were associated with increased LVEDP. The prevalence of advanced diastolic dysfunction increased with greater
Conflict of interest: Dr Min receives research support from Vital Images, serves on the speaker’s bureau, and is a consultant to GE Healthcare. The rest of the authors report no conflict of interest. * Corresponding author. E-mail address: [email protected] (F.Y. Lin). 1934-5925/$ e see front matter ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2013.08.008
290
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 2 8 9 e2 9 6
number of obstructive vessels. In multivariable analyses, SSS was associated with increased LVEDP (0.8 mm Hg per tertile increase in SSS, 0.5e1.1; P < .001); reduced E0 axial excursion (0.3; 95% confidence interval [CI], 0.5 to 0.1; P ¼ .001), increased LV mass index (1.6 g/m2 per tertile increase in SSS; P ¼ .04), and increased relative wall thickness (0.005; 95% CI, 0.004e0.009; P ¼ .03), with consistent relationships persisting even among persons with per-patient maximal stenosis
