Abstract
Background
Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are
strong predictors of cardiovascular events and share common risk factors. However,
their independent association remains unclear.
Methods
In the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated,
non-contrast chest computed tomography (CT) and echocardiography. The association
between left ventricular (LV) diastolic function and CAC was assessed using multidimensional
network and multivariable-adjusted regression analyses. Multivariable analysis was
conducted on continuous LV diastolic parameters and categorical classification of
LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using
reference limits from a low-risk reference group without established cardiovascular
disease, cardiovascular risk factors or evidence of CAC, (n = 560). We also classified
LVDD using the American Society of Echocardiography recommendations.
Results
The mean age of the participants was 51 ± 17 years with 56.6% female and 62.6% non-Hispanic
White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0.
An intertwined network was observed between diastolic parameters, CAC score, age,
LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e’, E/e’,
and LV mass index were independently associated with CAC after adjustment for traditional
risk factors. For both e’ and E/e’, the effect size and statistical significance were
higher across increasing CAC tertiles. Other independent correlates of e’ and E/e’
included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C,
and HDL cholesterol. The independent association with CAC was confirmed using categorical
analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived
thresholds.
Conclusion
In the PBHS study, the subclinical coronary atherosclerotic disease burden detected
using CAC scoring was independently associated with diastolic function.
Clinicaltrials.gov identifier
NCT03154346.
Keywords
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Article info
Publication history
Published online: July 04, 2022
Accepted:
June 20,
2022
Received in revised form:
May 23,
2022
Received:
February 7,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography.
