Chest Pain Without Coronary Artery Obstruction and Calcification in Young Women May Indicate Left Ventricular Diastolic Dysfunction

Abstract

Background: Left ventricular diastolic dysfunction (LVDD) and coronary artery calcification
become worse with increasing age. However, it is unclear whether there is a gender difference
in patients with chest pain but no obstructive coronary artery disease (CAD).
Aim: This study’s aim was to investigate whether gender and age differences existed in the association
between LVDD and the coronary artery calcium score (CACS) in patients with chest
pain but no obstructive CAD.
Methods: We retrospectively studied a total of 705 patients (age 65±13 years; men 342, 49%)
who had chest pain, normal LV ejection fraction on echocardiography, and no obstructive CAD
on computed tomography (CT) coronary angiography. LVDD was defined by the American
Society of Echocardiography recommendation of septal e’<8. Abnormal CACS was defined as
CACS of >0.
Results: Although, there was a significant difference in LVDD prevalence among patients with
normal and abnormal CACS (76.1% vs. 88.9%; p<0.001), in a multiple logistic regression
analysis, LVDD was not significantly associated with abnormal CACS. When the patients were
divided according to gender and age (decades; 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 years),
the proportion of men and women with abnormal CACS increased with age. On the other
hand, young women (age 20-39 years) with normal CACS showed a high LVDD prevalence,
although older women (age 60-69 years) and young men (age 20-39 years) had a low LVDD
prevalence.
Conclusions: Young women with chest pain but no obstructive and no calcified CAD, which
associated with LVDD. LV diastolic function assessment by echocardiography should be performed
in young women with chest pain even with normal CT coronary angiogram.