Choi Ki Hong, Kang Danbee, Lee Seung Hun, Kim Darae, Cho Sung Won, Choi Soo-Hee, Park Taek Kyu, Lee Joo Myung, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Cho Soo Jin, Yang Jeong Hoon
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
BMC Med. 2025 Feb 28;23(1):130. doi: 10.1186/s12916-025-03956-9.
The relationship between coronary artery calcium (CAC) and progression of diastolic dysfunction (DD) during longitudinal follow-up is uncertain. This study aimed to investigate the prevalence and progression of DD according to severity of CAC and understand their synergistic effect on mortality.
This was a population-based cohort study. All 15,193 adults who underwent a health screening exam with simultaneous echocardiography and CAC scan were enrolled. Definite DD (≥ 3/4 abnormal parameters for DD [e', E/e', tricuspid regurgitation velocity, and left atrial volume index]) and definite or probable DD (≥ 2/4) were defined. All-cause mortality was assessed based on the CAC and DD.
Among the population, 7995 participants (52.6%) had CAC = 0; 4661 (30.7%) had 0 < CAC < 100; and 2537 (16.7%) had CAC ≥ 100. The prevalence ratios for definite (adjusted ratio: 1.72, 95% CI: 1.23-2.22) and definite or probable DD (adjusted ratio: 1.83, 95% CI: 1.31-2.36) were significantly higher in individuals with CAC ≥ 100 than in those with CAC = 0. There was significant linear association of CAC with E/e' (adjusted p for linearity = 0.001). Compared with CAC < 100 without definite DD, the adjusted HRs with 95% CI for mortality of CAC ≥ 100 without definite DD, CAC < 100 with definite DD, and CAC ≥ 100 with definite DD were 2.56 (95% CI: 1.67-3.94), 3.08 (95% CI: 1.28-7.39), and 3.91 (95% CI: 1.68-9.10). Among participants without DD at CAC measurement who had at least two echocardiographic measurements, the presence of significant CAC (≥ 100) was significantly associated with accelerated progression in definite DD over time (adjusted HR: 1.46, 95% CI: 1.13-1.88), with more rapid elevation of E/e' during follow-up (difference: 0.06, 95% CI: 0.02-0.10, p = 0.003).
In the general population, there was a significant relationship between CAC and prevalence of DD, and both subclinical parameters were associated with increased mortality. Moreover, CAC ≥ 100 significantly affects the progression of DD independently of other clinical factors.
在纵向随访过程中，冠状动脉钙化（CAC）与舒张功能障碍（DD）进展之间的关系尚不确定。本研究旨在根据CAC严重程度调查DD的患病率和进展情况，并了解它们对死亡率的协同作用。
这是一项基于人群的队列研究。纳入了所有15193名同时接受超声心动图和CAC扫描的健康筛查成年人。定义了明确的DD（DD的异常参数≥3/4 [e'、E/e'、三尖瓣反流速度和左心房容积指数]）以及明确或可能的DD（≥2/4）。基于CAC和DD评估全因死亡率。
在该人群中，7995名参与者（52.6%）的CAC = 0；4661名（30.7%）的0 < CAC < 100；2537名（16.7%）的CAC≥100。CAC≥100的个体中明确DD（校正比值：1.72，95%CI：1.23 - 2.22）和明确或可能DD（校正比值：1.83，95%CI：1.31 - 2.36）的患病率显著高于CAC = 0的个体。CAC与E/e'存在显著的线性关联（线性校正p = 0.001）。与无明确DD且CAC < 100相比，无明确DD且CAC≥100、有明确DD且CAC < 100以及有明确DD且CAC≥100的死亡率校正HR（95%CI）分别为2.56（95%CI：1.67 - 3.94）、3.08（95%CI：1.28 - 7.39）和3.91（95%CI：1.68 - 9.10）。在CAC测量时无DD且至少有两次超声心动图测量的参与者中，显著CAC（≥100）的存在与明确DD随时间的加速进展显著相关（校正HR：1.46，95%CI：1.13 - 1.88），随访期间E/e'升高更快（差异：0.06，95%CI：0.02 - 0.10，p = 0.003）。
在一般人群中，CAC与DD患病率之间存在显著关系，这两个亚临床参数均与死亡率增加相关。此外，CAC≥100独立于其他临床因素显著影响DD的进展。
