Coronary artery plaque burden does not affect left ventricular diastolic function in asymptomatic adults with normal ejection fraction

Background: Coronary artery disease (CAD) is commonly cited as a mechanism underlying diastolic dysfunction. However, the association of CAD without ischemia and left ventricular (LV) diastolic dysfunction has not been convincingly demonstrated in asymptomatic patients. The objective of this study was to determine if such a relation exists using coronary artery calcium score (CACS) as a surrogate for coronary atherosclerosis burden. Methods: Consecutive eligible patients with normal ejection fraction who underwent CACS assessment, echocardiography, and stress testing with negative results for obstructive CAD between August 2006 and September 2007 were included in this retrospective study. Clinical variables were collected from the medical record. Diastolic function classification was based on established echocardiographic guidelines recommended by the American Society of Echocardiography. Statistical analysis was used to identify predictors of CACS. Results: A total of 349 subjects (302 men) aged 58 ± 6 years were studied. Risk factors included hyperlipidemia (n = 202 [58%]), hypertension (n = 127 [36%]), impaired fasting glucose (n = 78 [22%]), and diabetes (n = 21 [6%]). Left atrial volume index was weakly correlated with CACS (r = 0.26, P <.001). There was no significant relationship between CACS and LV diastolic function grade in the entire group (P =.14) or in a subgroup of younger patients (n = 140) who matched the ages qualifying for premature CAD (P =.17). After stepwise elimination multivariate analysis, five variables independently predicted CACS: age (P <.001), hyperlipidemia (P <.001), LA volume index (P <.001), male gender (P =.01), and LV posterior wall thickness (P =.03). Conclusions: In asymptomatic patients with normal LV ejection fraction and negative cardiac stress test results, CACS does not correlate with LV diastolic function as defined by established Doppler echocardiographic criteria. In the absence of ischemia, postinfarction LV remodeling, or previous coronary artery bypass surgery, CAD does not appear be a cause of LV diastolic dysfunction in asymptomatic patients.