Overlap between angina without obstructive coronary artery disease and left ventricular diastolic dysfunction with preserved ejection fraction

• Published in: PloS one Vol. 14; no. 5; p. e0216240
• Main Authors: Michelsen, Marie Mide, Pena, Adam, Mygind, Naja D, Høst, Nis, Gustafsson, Ida, Hansen, Peter Riis, Hansen, Henrik Steen, Kastrup, Jens, Prescott, Eva
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.05.2019; Public Library of Science (PLoS)
• Subjects: Aged; Angina; Angina pectoris; Angina Pectoris - physiopathology; Angiography; Blood pressure; Body mass; Body mass index; Body size; Cardiac patients; Cardiology; Cardiovascular disease; Cardiovascular diseases; Case-Control Studies; Comparative analysis; Congestive heart failure; Coronary artery; Coronary Artery Disease; Coronary heart disease; Coronary Stenosis; Coronary vessels; Cross-Sectional Studies; Deceleration; Diabetes mellitus; Disease control; Echocardiography; Ejection fraction; Female; Health aspects; Health risks; Heart diseases; Heart failure; Heart rate; Humans; Medical imaging; Medicine and Health Sciences; Middle Aged; Pain; Physical Sciences; Risk analysis; Risk factors; Statistical analysis; Stenosis; Stroke Volume; Task forces; Ventricle; Ventricular Dysfunction, Left - physiopathology; Denmark; Norway
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0216240

A link between angina with no obstructive coronary artery disease (CAD) and heart failure with preserved left ventricular ejection fraction has been proposed, but evidence in support of this is lacking. In a cross-sectional study, we investigated whether left ventricular diastolic function in women with angina pectoris and no obstructive CAD differed from a reference population. We included 956 women with angina and <50% coronary artery stenosis at invasive coronary angiography. Women with cardiovascular risk factors, but no history of chest pain or cardiac disease served as controls (n = 214). Left ventricular diastolic function was assessed by transthoracic echocardiography. The women with angina were slightly older, had higher body mass index, higher heart rate, and more had diabetes compared with controls while systolic blood pressure was lower. In age-adjusted analyses, angina patients had significantly lower E/A (Estimated difference -0.13, 95% CI: -0.17; -0.08), higher left ventricular mass index (5.73 g/m2, 95% CI: 3.71; 7.75), left atrial volume index (2.34 ml/m2, 95% CI: 1.23; 3.45) and E/e' (0.68, 95% CI: 0.30; 1.05) and a larger proportion had higher estimated left ventricular filling pressure (17% versus 6%, p = 0.001). No between group differences were seen for e' or deceleration time. After adjustment for known cardiovascular risk factors, between group differences for echocardiographic parameters remained statistically significant. Patients with angina and no obstructive CAD had a more impaired left ventricular diastolic function compared with an asymptomatic reference population. This suggests some common pathophysiological pathway between the two syndromes.