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Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study

  • Author Footnotes
    2 Both authors equally contributed to the manuscript.
    Francois Haddad
    Correspondence
    Corresponding author. Stanford University School of Medicine, 300 Pasteur drive, Stanford, CA 94304 USA.
    Footnotes
    2 Both authors equally contributed to the manuscript.
    Affiliations
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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  • Author Footnotes
    2 Both authors equally contributed to the manuscript.
    Nicholas Cauwenberghs
    Footnotes
    2 Both authors equally contributed to the manuscript.
    Affiliations
    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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  • Melissa A. Daubert
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • Yukari Kobayashi
    Affiliations
    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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  • Gerald S. Bloomfield
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • Dominik Fleischman
    Affiliations
    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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  • Lynne Koweek
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • David J. Maron
    Affiliations
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Prevention Research Center, Stanford University, Palo Alto, CA, USA
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  • Fatima Rodriguez
    Affiliations
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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  • Yaping Joyce Liao
    Affiliations
    Departments of Ophthalmology and Neurology, Stanford University School of Medicine, Stanford, CA, USA
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  • Kegan Moneghetti
    Affiliations
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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  • Myriam Amsallem
    Affiliations
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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  • Jessica Mega
    Affiliations
    Verily Inc., South San Francisco, CA, USA
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  • Adrian Hernandez
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • Robert Califf
    Affiliations
    Verily Inc., South San Francisco, CA, USA
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  • Kenneth W. Mahaffey
    Affiliations
    Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Stanford Center for Clinical Research (SCCR); Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
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  • Svati H. Shah
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • Author Footnotes
    1 Both authors are equivalent last authors.
    Tatiana Kuznetsova
    Footnotes
    1 Both authors are equivalent last authors.
    Affiliations
    Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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  • Author Footnotes
    1 Both authors are equivalent last authors.
    Pamela S. Douglas
    Footnotes
    1 Both authors are equivalent last authors.
    Affiliations
    Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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  • Project Baseline Health Study Investigators
  • Author Footnotes
    1 Both authors are equivalent last authors.
    2 Both authors equally contributed to the manuscript.

      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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