Coronary microvascular disease is a risk factor for left ventricular diastolic dysfunction: An AWARD substudy

Background: Left ventricular diastolic dysfunction (LVDD) caused by myocardial ischemia is an important pathogenetic factor in the development of heart failure with preserved ejection fraction (HFpEF). Objective: To explore the differences in LVDD triggered by two ischemic injuries (microvascular lesions and epicardial stenosis). Methods: Angiographic function indicators involving angiography-derived index of microcirculatory (AMR) simulating hyperemic velocity (SHV) and diagnostic indicators for LVDD including average E/e', septal e’velocity, and lateral e’velocity (based on echocardiography) were derived from records of enrolled patients suffering from coronary microvascular disease (CMVD) or obstructive coronary artery disease (CAD) (without microvascular dysfunction). The linear correlation between AMR, SHV, and echocardiographic indicators was evaluated by the Spearman's coefficient method. And logistics regression analyses evaluated risk factors for LVDD. Besides, we performed the by stratified analysis to explore Differences in AMR and SHV distribution between LVDD and non-LVDD groups. Finally, receiver operating characteristic (ROC) analyses evaluated the efficacy of AMR in recognizing LVDD. Results: CMVD was more susceptible to LVDD compared to obstructive-CAD (18.8% vs. 6.2%). AMR, SHV were linearly correlated with the relevant indicators of LVDD. And in the CMVD group, AMR were higher in the LVDD group than in the non-LVDD group, while SHV was opposite. Furthermore, AMR promoted LVDD (OR=1.02), whereas SHV inhibited the formation of LVDD (OR=0.59). ROC analyses revealed AMR can identify LADD. Conclusion: Microvascular lesions are more susceptible to LVDD.