Coronary microvascular dysfunction and atrial reservoir function

• Published in: Cardiovascular ultrasound Vol. 22; no. 1; p. 5
• Main Authors: Mela, Julien La, Riou, Laurent, Barone-Rochette, Gilles
• Format: Journal Article
• Language: English
• Published: England BioMed Central 14.05.2024; BMC
• Subjects: Abnormalities; Adenosine; Aged; Angina pectoris; Atrial Function, Left - physiology; Blood pressure; Cardiac arrhythmia; Catheters; Coronary artery; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Circulation - physiology; Coronary microvascular dysfunction; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Diastole; Doppler effect; Echocardiography; Echocardiography - methods; Ejection fraction; Female; Heart; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart attacks; Heart failure; Humans; Left atrial strain reservoir; Male; Medical imaging; Microcirculation - physiology; Microvasculature; Middle Aged; Patients; Physiology; Pulmonary arteries; Regression analysis; Sensors; Software; Structure-function relationships; Thermodilution - methods; Veins & arteries; United States > US; Coronary microvascular dysfunction; Left atrial strain reservoir
• ISSN: 1476-7120; 1476-7120
• DOI: 10.1186/s12947-024-00324-0

Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the coronary microcirculation, which may be diagnosed using invasive coronary physiology. CMD is responsible for impaired diastolic cardiac function. It has recently been suggested that left atrial strain (LASr) represents a highly sensitive tool for detecting cardiac diastolic function abnormalities. Accordingly, the aim of this study was to investigate the relationship between CMD and LASr. Consecutively enrolled patients with non-obstructed coronary arteries (NOCA) underwent CMD and LASr evaluation by invasive thermodilution and noninvasive echocardiography, respectively. Forty-two (42) patients were included, out of which 26 presented with CMD. There were no significant differences between CMD-positive and negative patients in terms of clinical and echocardiographic characteristics. LASr was significantly reduced in patients with CMD (24.6% ± 6.1 vs. 30.3 ± 7.8%, p = 0.01). A moderate correlation was observed between coronary flow reserve and LAsr (r = 0.47, p = 0.002). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LASr (OR = 0.88, 95%CI 0.78-0.99.135, p = 0.04). A LASr cut-off of 25.5% enabled an optimal classification of patients with or without CMD. Patients with NOCA and CMD had a significantly reduced LASr compared with patients without CMD, suggesting the early impairment of diastolic function in these patients.