Abstract P166: Subendocardial Viability Ratio Associates With Diastolic Function Parameters: Insights From the Bogalusa Heart Study

Abstract

Introduction: Recent evidence has linked coronary microvascular dysfunction to impaired diastolic function and severity in heart failure with preserved fraction (HFpEF). While echocardiography remains pivotal in the assessment of this clinical scenario, information is scant on the role of applanation tonometry-derived estimates of coronary microcirculation, such as the subendocardial viability ratio (SEVR), in the evaluation of diastolic function. Hypothesis: We hypothesized that SEVR is associated with diastolic function parameters in relatively young and healthy adults in a community setting. Methods: We examined 611 participants of the Bogalusa Heart Study (31.3% black, 54.6% female, aged 29 to 51 years) who underwent 2D and Doppler echocardiography as well as pulse-wave analysis via applanation tonometry of the radial artery. Echocardiographic parameters of diastolic function included mitral annular velocity (e’), peak early filling velocity (E), peak velocity cause by atrial contraction (A), isovolumic relaxation time (IVRT), and deceleration time (DT). Diastolic function and SEVR relationships were evaluated with multivariable-adjusted linear regression. Covariates adjusted for included age, race, sex, systolic blood pressure, high density lipoprotein cholesterol, low density lipoprotein cholesterol, serum triglycerides, glucose, body mass index, cigarette smoking as well as blood pressure and lipid medications. Results: Compared to men, women had a lower SEVR (p < 0.001). There were no significant sex or race differences in diastolic function parameters, except that black females had lower E/e’ ratios compared to black males (p=0.003). SEVR was significantly associated with the E/A ratio (β=0.20, p<0.001) as well as DT (β=0.32, p<0.001), while no significant associations were found between SEVR and the E/e’ ratio or IVRT. Neither sex nor race modified the relationship of SEVR with E/A ratio, DT, E/e’ ratio, or IVRT. Conclusion: In middle-aged adults, SEVR is significantly associated with traditional echocardiographic parameters of diastolic function, including both the E/A ratio and DT. Pulse wave analysis via applanation tonometry is an inexpensive non-invasive tool that may aid in accelerating the diagnosis of diastolic dysfunction in the individuals without overt disease.