Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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.
J Cardiovasc Comput Tomogr. 2022 Nov-Dec;16(6):498-508. doi: 10.1016/j.jcct.2022.06.003. Epub 2022 Jul 5.
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.
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.
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.
In the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function.
NCT03154346.
冠状动脉钙（CAC）和左心室舒张功能障碍（LVDD）是心血管事件的强有力预测因子，它们具有共同的危险因素。然而，它们的独立相关性尚不清楚。
在基线健康研究（PBHS）中，2082 名参与者接受了心脏门控、非对比胸部 CT 和超声心动图检查。使用多维网络和多变量调整回归分析评估左心室（LV）舒张功能与 CAC 之间的关系。对连续的 LV 舒张参数和 LVDD 的分类进行多变量分析，并根据传统的心脏代谢危险因素进行调整。LVDD 使用无既定心血管疾病、心血管危险因素或 CAC 证据的低危参考组的参考限值进行定义（n=560）。我们还根据美国超声心动图学会的建议对 LVDD 进行分类。
参与者的平均年龄为 51±17 岁，女性占 56.6%，非西班牙裔白人占 62.6%。总体而言，38.1%患有高血压；13.7%患有糖尿病；39.9%的 CAC>0。在舒张参数、CAC 评分、年龄、LV 质量指数和脉压之间观察到一个相互交织的网络。在多变量调整分析中，在调整传统危险因素后，e'、E/e'和 LV 质量指数与 CAC 独立相关。对于 e'和 E/e'，随着 CAC 三分位的增加，其效应大小和统计学意义更高。e'和 E/e'的其他独立相关因素包括年龄、女性、黑人种族、身高、体重、脉压、糖化血红蛋白和高密度脂蛋白胆固醇。使用人群衍生阈值在 554 名参与者（26.6%）中进行 LVDD 的分类分析，证实了与 CAC 的独立相关性。
在 PBHS 研究中，使用 CAC 评分检测到的亚临床冠状动脉粥样硬化疾病负担与舒张功能独立相关。
NCT03154346。
