Abstract 19062: Prognostic Impact of Coronary Microvascular Dysfunction on Diastolic Dysfunction and Cardiovascular Events in Patients With Acute Coronary Syndrome

Abstract

Introduction: Coronary microvascular dysfunction (CMD) has prognostic value in coronary artery disease. Hypothesis: CMD could have an influence on progression of diastolic dysfunction and occurrence of cardiovascular events in acute coronary syndrome (ACS). Methods: We prospectively enrolled ACS patients who underwent successful percutaneous coronary intervention (PCI). CMD was defined by index of microcirculatory resistance (IMR >40) after PCI. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e’ velocity, tricuspid regurgitation velocity, and left atrial volume index). The primary end point was 1-year diastolic dysfunction and secondary end point was cardiovascular death or admission for heart failure during 5 years of follow-up. Results: Among 163 patients, 39 patients (23.9%) had CMD. Prevalence of 1-year diastolic dysfunction was increased during 1 year (baseline 29.4% vs. 1 year 46.0%). Progression rate of diastolic dysfunction during 1 year was significantly higher in CMD (40.3% vs. 64.1%, OR 2.64, p=0.008) (Figure). After adjustment with clinical variables, presence of CMD was strongly associated with progression of 1-year diastolic dysfunction (HR, 2.95, 95% CI 1.30 - 8.74, p=0.030). Risk of cardiovascular death or admission for heart failure was increased in CMD (37.9% vs. 7.1%; Log-rank test p=0.003) Conclusions: This study showed the association between presence of CMD and progression of diastolic dysfunction during 1 year, they might have synergistic influence on occurrence of cardiovascular events in ACS patients.