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dc.contributor.authorLin, Fay Y.
dc.contributor.authorZemedkun, Micheas
dc.contributor.authorDunning, Allison
dc.contributor.authorGomez, Millie
dc.contributor.authorLabounty, Troy M.
dc.contributor.authorAsim, Muhammad
dc.contributor.authorHorn, Evelyn
dc.contributor.authorAurigemma, Gerard P.
dc.contributor.authorMaurer, Matthew S.
dc.contributor.authorRoman, Mary
dc.contributor.authorDevereux, Richard
dc.contributor.authorMin, James K.
dc.date2022-08-11T08:08:31.000
dc.date.accessioned2022-08-23T15:57:56Z
dc.date.available2022-08-23T15:57:56Z
dc.date.issued2013-09-01
dc.date.submitted2015-03-24
dc.identifier.citationJ Cardiovasc Comput Tomogr. 2013 Sep-Oct;7(5):289-96.e1. doi: 10.1016/j.jcct.2013.08.008. Epub 2013 Sep 26. <a href="http://dx.doi.org/10.1016/j.jcct.2013.08.008">Link to article on publisher's site</a>
dc.identifier.issn1876-861X (Linking)
dc.identifier.doi10.1016/j.jcct.2013.08.008
dc.identifier.pmid24268115
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30317
dc.description.abstractBACKGROUND: Patients with flow-limiting coronary stenoses exhibit elevated left ventricular end-diastolic pressure (LVEDP) and abnormal left ventricular (LV) relaxation. OBJECTIVE: We investigated the relationship of extent and severity of coronary artery disease (CAD) by coronary CT angiography (CTA) to LVEDP and measures of LV diastolic dysfunction. METHODS: We identified consecutive patients undergoing coronary CTA and transthoracic echocardiography who were assessed for diastolic function. CAD was evaluated on a per-patient, per-vessel, and per-segment basis for intraluminal diameter stenosis by using an 18-segment model (0 = none, 1 = 1%-49%, 2 = 50%-69%, and 3 = 70%-100%) and summed over segments to obtain overall coronary plaque burden (segment stenosis score [SSS]; maximum = 54). Transthoracic echocardiography evaluated mitral inflow E wave-to-A wave ratio, tissue Doppler early mitral annual tissue velocity axial excursion, stage of diastolic dysfunction, and LV dimensions and estimated LVEDP from the ratio of mitral inflow velocity to early mitral annular (medial) tissue velocity. RESULTS: Four hundred seventy-eight patients (57% women; mean age, 57.9 +/- 14.6 years; 24.9% prior CAD) comprised the study population. Increasing per-patient maximal coronary stenosis, number of vessels with obstructive stenosis, and SSS were associated with increased LVEDP. The prevalence of advanced diastolic dysfunction increased with greater number of obstructive vessels. In multivariable analyses, SSS was associated with increased LVEDP (0.8 mm Hg per tertile increase in SSS, 0.5-1.1; P < .001); reduced E' axial excursion (-0.3; 95% confidence interval [CI], -0.5 to -0.1; P = .001), increased LV mass index (1.6 g/m(2) per tertile increase in SSS; P = .04), and increased relative wall thickness (0.005; 95% CI, 0.004-0.009; P = .03), with consistent relationships persisting even among persons with per-patient maximal stenosis < 50% and LV ejection fraction >>= 55%. CONCLUSIONS: Extent and severity of obstructive as well as nonobstructive CAD by coronary CTA are associated with increased LVEDP and measures of diastolic dysfunction. Elsevier Inc. All rights reserved.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=24268115&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.jcct.2013.08.008
dc.subjectAdult
dc.subjectAged
dc.subjectChi-Square Distribution
dc.subjectCoronary Angiography
dc.subjectCoronary Artery Disease
dc.subjectCoronary Vessels
dc.subject*Diastole
dc.subjectEchocardiography, Doppler
dc.subjectFemale
dc.subjectHumans
dc.subjectLinear Models
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMitral Valve
dc.subjectModels, Cardiovascular
dc.subjectMultivariate Analysis
dc.subjectPredictive Value of Tests
dc.subjectRadiographic Image Interpretation, Computer-Assisted
dc.subjectSeverity of Illness Index
dc.subjectStroke Volume
dc.subject*Tomography, X-Ray Computed
dc.subjectVentricular Dysfunction, Left
dc.subject*Ventricular Function, Left
dc.subjectCardiology
dc.subjectCardiovascular Diseases
dc.titleExtent and severity of coronary artery disease by coronary CT angiography is associated with elevated left ventricular diastolic pressures and worsening diastolic function
dc.typeJournal Article
dc.source.journaltitleJournal of cardiovascular computed tomography
dc.source.volume7
dc.source.issue5
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/583
dc.identifier.contextkey6889248
html.description.abstract<p>BACKGROUND: Patients with flow-limiting coronary stenoses exhibit elevated left ventricular end-diastolic pressure (LVEDP) and abnormal left ventricular (LV) relaxation.</p> <p>OBJECTIVE: We investigated the relationship of extent and severity of coronary artery disease (CAD) by coronary CT angiography (CTA) to LVEDP and measures of LV diastolic dysfunction.</p> <p>METHODS: We identified consecutive patients undergoing coronary CTA and transthoracic echocardiography who were assessed for diastolic function. CAD was evaluated on a per-patient, per-vessel, and per-segment basis for intraluminal diameter stenosis by using an 18-segment model (0 = none, 1 = 1%-49%, 2 = 50%-69%, and 3 = 70%-100%) and summed over segments to obtain overall coronary plaque burden (segment stenosis score [SSS]; maximum = 54). Transthoracic echocardiography evaluated mitral inflow E wave-to-A wave ratio, tissue Doppler early mitral annual tissue velocity axial excursion, stage of diastolic dysfunction, and LV dimensions and estimated LVEDP from the ratio of mitral inflow velocity to early mitral annular (medial) tissue velocity.</p> <p>RESULTS: Four hundred seventy-eight patients (57% women; mean age, 57.9 +/- 14.6 years; 24.9% prior CAD) comprised the study population. Increasing per-patient maximal coronary stenosis, number of vessels with obstructive stenosis, and SSS were associated with increased LVEDP. The prevalence of advanced diastolic dysfunction increased with greater number of obstructive vessels. In multivariable analyses, SSS was associated with increased LVEDP (0.8 mm Hg per tertile increase in SSS, 0.5-1.1; P < .001); reduced E' axial excursion (-0.3; 95% confidence interval [CI], -0.5 to -0.1; P = .001), increased LV mass index (1.6 g/m(2) per tertile increase in SSS; P = .04), and increased relative wall thickness (0.005; 95% CI, 0.004-0.009; P = .03), with consistent relationships persisting even among persons with per-patient maximal stenosis < 50% and LV ejection fraction >>= 55%.</p> <p>CONCLUSIONS: Extent and severity of obstructive as well as nonobstructive CAD by coronary CTA are associated with increased LVEDP and measures of diastolic dysfunction. Elsevier Inc. All rights reserved.</p>
dc.identifier.submissionpathfaculty_pubs/583
dc.contributor.departmentDepartment of Medicine, Division of Cardiovascular Medicine
dc.source.pages289-96.e1


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