The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease

The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease Liang Lv, Yannan Xu, Qiong Zhang, Shanshan Kan, Xiaoming Chen, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1287458/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Previous studies of left ventricular diastolic function (LVDF) have focused on the decrease in active and passive diastolic function due to ischemic factors but have not investigated if the decrease in compliance of the coronary arteries that bypass the surface of the heart and travel between the myocardium could cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis. Methods and Results: From October 2016 to October 2019, the Department of Cardiology of Fengxian District Central Hospital treated 581 patients diagnosed with coronary heart disease (CHD). They were divided into groups according to the degree of coronary stenosis, the number of stents and the length of stents implanted. It was concluded that there was a statistical difference in Gensini scores between patients in groups B, C and D (P<0.001). And multiple linear regression analysis showed that T was correlated with Gensini score and C-dp/dtmax(R=0.711, P<0.001). Grouping according to the site of stent implantation and the number of stents implanted, it was found out that the changes in T values before and after left anterior descending artery (LAD) stent implantation were greater than left circumflex artery (LCX) and right coronary artery (RCA) (P<0.001). And multiple linear regression revealed a correlation between T values and stent length, ventricular stiffness, and C-dp/dtmax(P=0.001). Conclusions: The decrease in compliance of the coronary arteries bypassing the surface of the heart and travelling between the myocardium would cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction In recent years, coronary artery atherosclerotic heart disease has caused an increasement in morbidity and mortality rate and is the leading cause of death worldwide[ 1 ]. Several studies have shown that coronary artery disease could cause structural remodeling of the left ventricle, adversely affecting left ventricular diastole and myocardial stiffness leading to reduced left ventricular diastole and increased stiffness, which in turn increases cardiac filling pressures and diastolic insufficiency prior to ventricular systolic dysfunction[ 2 , 3 ]. Left ventricular diastolic dysfunction (LVDD), which occurs in up to 34% of patients with coronary artery disease, is closely associated with myocardial ischemia and has been shown to alter its clinical course[ 4 – 6 ]. Non-obstructive coronary sclerotic plaques are not sufficient to cause myocardial ischemia but can promote alterations in vascular tone function and may also alter LVDF[ 4 , 7 ], while it has been suggested that preventing the development of atherosclerosis may help to reduce the incidence of LVDD in the diabetic population [ 8 ], suggesting that coronary sclerosis may be involved in the development of LVDD independently of myocardial ischemia affecting vascular elasticity. Atherosclerosis of the coronary arteries, which travel on the surface of the heart, and the rich network of capillaries distributed between the myocardium, are essential for the supply of blood to the myocardium. And atherosclerosis of the coronary arteries leads to a decrease in vascular elasticity, which has a constricting effect on the heart like that of myocardial fibrosis on the ventricular wall. The effect theoretically also causes a decrease in myocardial diastolic function. Previous studies have focused on the reduction in active and passive diastolic function due to ischemic factors but less on coronary atherosclerosis. PCI is currently the choice of treatment for patients with coronary artery disease who have severe stenosis [ 9 ]. One study showed that half of patients’ diastolic function improved in 3-4 years after PCI, while diastolic function remained unchanged or worsened in the remaining patients [ 10 ]; another study showed an improvement in left ventricular diastolic function 3 months after stenting [ 11 ], suggesting that PCI may affect LVDF in patients, but these studies did not further investigate if the reduced coronary artery compliance caused by stenting influences LVDF. Therefore, it is necessary to investigate if coronary atherosclerosis and the reduced compliance of coronary arteries and small vessels distributed between the myocardium caused by the implantation of stents during PCI could cause a certain constricting effect on the heart and thus affect the diastolic function of the heart, so that the changes in diastolic function in patients undergoing PCI with stents can be investigated and appropriate therapeutic measures can be taken in a timely and rapid manner to delay or prevent the onset of left ventricular diastolic insufficiency. Methods Study Design and Patients Inclusion subjects: From October 2016 to October 2019, 581 patients diagnosed with CHD in the Department of Cardiology, Fengxian District Central Hospital, of which 318 patients underwent PCI (Figure 1), were selected under a retrospective study. All enrolled patients signed an informed consent form, and the study was approved by the Ethics Committee of the Sixth People's Hospital of Shanghai Jiao Tong University South Hospital. Inclusion criteria: (1) the diagnostic criteria for unstable angina referred to the 2007 release of the Chinese Society of Cardiovascular Diseases; (2) the age was controlled from 18 to 75 years old; (3) Doppler ultrasound examination was performed within 3 days before PCI and 1 year after the repeat imaging, and the left ventricular ejection fraction was greater than 50%; (4) complete clinical data; (5) no history of iodine allergy. Exclusion criteria: (1) patients with a combined history of acute myocardial infarction or old myocardial infarction; (2) various organic heart diseases such as rheumatic heart valve disease, cardiomyopathy, myocardial amyloidosis, ventricular wall tumor, congenital heart disease and pericardial disease as suggested by cardiac ultrasound; (3) patients with heart failure of New York Heart Association (NYHA) cardiac function class III or above; (4) patients with chronic obstructive pulmonary disease (5) patients with atrial fibrillation; (6) patients with chronic underlying diseases such as severe hepatic or renal insufficiency or severe anemia; (7) patients requiring repeat PCI; and (8) patients with co-infectious diseases. Coronary Angiography and Intervention Coronary angiography and stenting were performed using standard interventional techniques according to the practice guidelines established by the Chinese Society of Interventional Cardiology. Cardiac catheterization and hemodynamic measurements were performed using a large C-wall digital subtraction X-ray system (Model: AXIOM Artis Zee Celling, Device serial number: 147191, Device identification number: 720-939180) and its matching polysomnography. Coronary angiography was performed by an experienced associate chief cardiologist or above, using multiple projections. And two experienced cardiac catheterists quantitatively evaluated the presence or absence of stenosis and vascular stenosis, selected for stent implantation according to the degree of coronary lesion, and collected the length and number of stents in patients with stent implantation. The successful PCI refers to: residual coronary stenosis <10% after stent implantation, and visualized after angiography Assessment without significant intimal tears, distal embolism, coronary slow flow, occluded side branch occlusion. Gensini scoring method: all patients were scored for each patient's coronary lesion using the modified Gensini score under American Heart Association criteria [ 12 ]. DF Measurement and Analysis Left ventriculography: Patients were instructed to assume a right anterior oblique position, photographed at a 30° angle and the contrast agent iodixanol was injected at a certain rate using a high-pressure syringe, with 50 frames/s as the filming speed for coronary angiography in patients with coronary artery disease. Measurements were made according to the playback. The electrocardiogram, left ventricular pressure curve and aortic pressure curve are also recorded simultaneously for at least 5 consecutive cardiac cycles. Measurement of left ventricular diastolic function indicators: maximum left ventricular filling rate (PFR), maximum rate of left ventricular pressure rise (LV+dp/dtmax) and maximum rate of left ventricular pressure fall (LV-dp/dtmax), systolic+dp/dtmax and diastolic-dp/dtmax, and left ventricular isovolumic diastolic relaxation are measured according to the left ventricular pressure curve using a pressure guidewire system. Time constant of relaxation (T, normal value is <40 ms) refers to the time between the peak dp/dt and the end-diastolic pressure of the left ventricle. Δ P = P u - P l ( P u , Pressure upper limit; P l , Pressure lower limit; t, time of pressure changes between P1 and P2) The inverse of the slope of this line is T, which reflects active left ventricular diastolic function [ 13 – 16 ]. The left ventricular stiffness index (K) is obtained by approximating the Diastolic-Pressure-Volume Curve (DPV) using the data points collected at the end of diastole. The tangent slope of any point on this curve (dP/dV) is called the left ventricular lumen stiffness. And K is the slope of the linear relationship between ventricular stiffness and ventricular pressure, reflecting left ventricular Passive diastolic function [ 17 , 18 ]. Coronary pressure was measured by end-diastolic coronary volume (CEDV), end-systolic coronary volume (CESV), maximum rate of increase in coronary pressure (C+dp/dtmax). Maximum rate of decrease in coronary pressure(C-dp/dtmax) were measured using pressure guidewires as described above. The coronary angiography (CAG) was reviewed in all patients from 9 months to 1 year after stenting, and indicators reflecting cardiac volumes, size and left ventricular systolic and diastolic function were collected. Coronary 64-layer spiral CT: A retrospective cardiac gated spiral scan was performed using a Philips Brilliance 64-layer CT machine to select an appropriate scan protocol. After the scan, 20 (5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 95%, 100%) ECGs were obtained by automatic offline reconstruction using 5% intervals with a reconstruction layer thickness of 1.5 mm and a spacing of 1.0 mm, Kemal value (convolution value) B26f. (90%, 95%, 100%) cardiac cycles. The reconstructed images were transferred to the Syngo workstation, and the 5%-100% full-phase images were transferred to the Circulation software for analysis of cardiac function. 21 time-phase reconstructions were transferred to the post-processing workstation, where two experienced image physicians were selected to perform post-processing and calculate left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular systolic volume (LVESV). end-diastolic volume (LVEDV), left ventricular systolic volume (LVESV), maximum rate of left ventricular pressure rise (LV+dp/dtmax), maximum rate of left ventricular pressure fall (LV-dp/dtmax), maximum left ventricular filling rate (PFR), and left ventricular ejection fraction (LVEF). Statistical Analysis Baseline demographic data and clinical variables were summarized with continuous variables and expressed as mean ± standard deviation or median with interquartile range. Categorical data were expressed as percentages and number of events. ANOVA or Kruskal-Wallis non-parametric tests for continuous variables as applicable, and χ2 tests for categorical data were used to compare if there were differences in LVDF among groups. All analyses used SPSS software version 25.0. The statistical significance of all the analyses was drawn at a 2-sided significance level, which was 0.05. Results 540 patients treated with PCI were analyzed by a complete data set including LV diastolic function assessed at baseline and follow-up (Table 1 ). The four groups of patients aged 63.0 ± 9.5 years old and 47.8% of them were male. Patients in group D had higher blood cholesterol, blood creatinine and BNP compared with those in group A. Control patients were selected and grouped by an age interval of 10: group 1 (45 ≤ age < 55), group 2 (55 ≤ age < 65), group 3 (65 ≤ age < 75), group 4 (75 ≤ age < 85),group 5 (85 ≤ age) ( A statistically significant difference (F=13.893, p<0.001) was found that the T values of patients in the different age groups were of statistical values with an increase in the T value of the corresponding diastolic function index as the age of the patients increased (Figure 2 ); also, a one-way ANOVA of the Gensini scores of patients in groups B, C and D showed a statistically significant difference (p<0.001). As the degree of coronary artery disease increased, a comparison of DT and LAD measured by echocardiography and T values measured by invasive catheterization, which more accurately reflect the diastolic function of the left ventricle, revealed that patients in groups C and D where the degree of coronary stenosis was greater than 50%, showed a more significant decrease in diastolic function than patients in groups A and B. Patients in group D had poorer diastolic function than those in group C. Correlation analysis of patients in group D with T as the dependent variable showed a correlation between T and Gensini score and C-dp/dtmax (Pearson R=0.696, -0.540, p<0.001) and multiple linear regression analysis showed a linear correlation between T and Gensini score and C-dp/dtmax (R=0.711, B=0.575, -0.197, p<0.001). 0.711, B=0.575, -0.197, P<0.001). As the degree of coronary atherosclerosis increased, the patient's left ventricular diastolic function also progressively decreased. Table 1 Baseline Characteristics of the Study Patients With CAD Undergoing PCI A B C D P value ( n=97 ) ( n=114 ) ( n=52 ) (n=318) Male (%) 20(35.7) 46(40.4) 33(63.5) 164(51.6) >0.05 Age, years 61.6(11.0) 64.6(11.0) 64.8(10.2) 62.4(8.4) 0.027 BSA, m2 1.77(0.16) 1.78(0.19) 1.78(0.37) 1.73(0.15) 0.085 Smoker (%) 12(21.4) 28(24.6) 22(42.3) 125(39.3) >0.05 Hypertension (%) 25(44.6) 65(57.0) 37(71.2) 200(62.9) >0.05 Diabetes (%) 5(8.9) 14(12.3) 11(21.2) 54(17.0) >0.05 LDL, mmol/L 2.3(0.6) 2.5(0.6) 2.3(0.7) 2.3(0.5) 0.091 HDL, mmol/L 1.1(0.3) 1.1(0.3) 1.1 (0.3) 1.1(0.3) 0.611 Serum cholesterol, mmol/L 1.4(0.4) 1.6(0.9) 1.7(1.1) 3.9(0.8) <0.001 Fasting glucose, mmol/L 6.20 (5.16-7.78) 6.05 (5.60-7.00) 6.00 (5.35-7.10) 6.23 (4.53-7.70) 0.601 Serum triglyceride, mmol/L 1.45 (0.72-2.40) 1.22 (0.94-1.77) 1.28 (0.93-1.78) 1.63 (0.93-2.55) 0.097 Serum creatinine, mmol/L 63.5 (49.5-70.5) 65.0 (52.0-71.0) 72.0 (66.0-89.5) 72.9 (56.4-92.3) <0.001 BNP, ng/ml 46.4 (23.9-55.1) 46.2 (28.8-71.8) 33.7 (22.7-50.8) 115.0 (23.7-269.8) <0.001 Gensini score 0.00 a 4.0 (2.5-5.0) b 14.5 (10.0-17.25) c 38.0 (33.2-43.6) d <0.001 Angiographic and procedural findings DT, ms 169.1(61.8) a 189.8(43.4) a 217.2(39.1) b 235.7(79.6) b <0.001 EF 70.1(4.8) a 69.5(5.2) a 69.3(4.6) a 65.5(9.1) b <0.001 LAD, mm 31.8(2.9) a 32.0(3.3) a 35.1(4.9) b 35.1(6.6) b <0.001 E/e' 8.4(0.8) a 9.9(1.6) b 11.3(1.4) c 14.6(2.2) d <0.001 PFR, ml/s 264.9(19.1) a 242.3(27.9) b 227.2(21.8) b 203.3(14.8) c <0.001 T, ms 33.0(7.6) a 34.0(5.0) a 38.5(6.3) b 43.2(3.8) c <0.001 A: control group, B: coronary artery atherosclerosis group, C:coronary artery atherosclerotic heart disease group, D: PCI group. Values are mean±standard deviation or n (%). BSA, body surface area; LDL, low-density lipoprotein; HDL, high-density lipoprotein; BNP, brain natriuretic peptide; DT, deceleration time (ms); EF, ejection fraction (%); LAD, anteroposterior diameter of left atrium; PFR, peak early filling rate; T, time constant of relaxation. Each subscript letter denotes a subset of categories whose row proportions do not differ significantly from each other at the .05 level. According to the stent implantation site, patients in Group D were divided into LAD, LCX and RCA groups and further investigated for changes in diastolic function indices preoperatively, immediately postoperatively and 1 year postoperatively. Among the patients with single stents, those with LAD stents got lower preoperative PFR indexes than those with LCX and RCA stents while T, K, LV+dp/dtmax and LV-dp/dtmax indexes were significantly higher than thoses with LCX and RCA stents, and the differences were statistically significant (P<0.001). T, K, LV+dp/dtmax and LV-dp/dtmax were higher than those before surgery and the difference was of statistical significance. Diastolic function decreased further, and diastolic function indicators gradually recovered after 1 year postoperatively (Table 2 ). The correlation between T and stent length, Gensini score, ventricular stiffness, LV-dp/dtmax, CEDV, CESV and C-dp/dtmax was statistically significant, while multiple linear regression with T as the dependent variable revealed that stent length, C-dp/dtmax and ventricular stiffness were statistically significant (Table 3 ). Table 2 LAD single stent - left ventricular diastolic function data LAD LCX RCA P value (n=129) ( n=29 ) ( n=34 ) Pre-PCI PFR 198.3(8.8) * 225.4(11.2) 225.2(12.0) <0.001 T 43.8(3.7) * 39.6(0.9) 40.9(3.7) <0.001 K 4.9(0.6) * 4.3(0.2) 4.1(0.2) <0.001 LV+dp/dtmax 2305.7 (2257.1-2364.4) * 2012.5 (2005.2-2027.1) 2005.3 (1973.0-2049.5) <0.001 LV-dp/dtmax 2207.5 (2166.6-2247.5) * 1899.0 (1888.7-1911.6) 1903.1 (1893.7-1919.2) <0.001 CEDV 3.8(0.1) * 4.2(0.1) 4.1(0.1) <0.001 CESV 3.1(0.2) 3.1(0.1) 3.1(0.1) 0.062 C+dp/dtmax 1941.4(360.7) 2089.2(104.7) 2077.4(65.7) 0.005 C-dp/dtmax 1680.1(250.7) 1753.1(81.1) 1749.1(54.1) 0.163 IM-post-PCI Stent length 25.9(6.4) 24.5(5.7) 23.6(4.7) 0.168 PFR 183.1(23.1) * 226.0(11.0) 225.8(12.5) <0.001 T 47.5(4.0) * 39.5(1.1) 39.7(2.6) <0.001 K 5.9(0.2) * 4.2(0.3) 4.1(0.1) <0.001 LV+dp/dtmax 2477.0 (2446.4-2535.4) * 2026.2 (1998.9-2088.0) 2010.7 (1972.4-2054.6) <0.001 LV-dp/dtmax 2295.6 (2243.9-2348.5) * 1903.5 (1890.9-1921.7) 1906.0 (1891.1-1930.8) <0.001 CEDV 3.4(0.1) * 4.2(0.1) 4.2(0.1) <0.001 CESV 2.7(0.3) * 3.1(0.1) 3.1(0.1) <0.001 C+dp/dtmax 1747.7(365.6) * 2087.2(111.5) 2068.1(92.9) <0.001 C-dp/dtmax 1495.0(259.9) * 1753.9(82.4) 1747.9(53.0) <0.001 Post-PCI PFR 222.5(18.3) 225.4(11.2) 225.2(12.0) 0.986 T 40.6(4.2) 39.6(1.7) 40.2(1.7) 0.479 K 4.2(0.6) 4.2(0.2) 4.1(0.2) 0.113 LV+dp/dtmax 2075.0 (1881.9-2225.4) 2068.5 (1974.9-2117.7) 2010.5 (1969.5-2059.7) 0.252 LV-dp/dtmax 1872.6 (1731.0-2019.3) 1897.4 (1834.6-1928.5) 1899.0 (1864.7-1958.1) 0.673 CEDV 4.1(0.1) 4.1(0.3) 4.1(0.4) 0.831 CESV 3.1(0.4) 3.1(0.3) 3.1(0.4) 0.906 C+dp/dtmax 2097.0(311.7) 2091.4(134.6) 2080.9(118.7) 0.874 C-dp/dtmax 1828.7(224.2) 1756.2(151.8) 1765.8(120.0) 0.121 Values are mean±standard deviation or median (interquartile spacing). K, stiffness index; LV+dp/dtmax, maximum rate of left ventricular pressure rise; LV-dp/dtmax, maximum rate of left ventricular pressure drop; CEDV, coronary artery end-diastolic volume; CESV, coronary artery end-systolic volume; C+dp/dtmax, maximum rate of coronary artery pressure rise; C-dp/dtmax, maximum rate of coronary artery pressure drop. '*'indicates that the difference is statistically significant in the same row. Table 3 Correlation of T and clinical parameters. Variables r P value stent length 0.437 <0.001 Gensini score 0.305 <0.001 K 0.409 <0.001 LV-dp/dtmax -0.198 0.024 CEDV -0.187 0.034 CESV -0.252 0.004 C-dp/dtmax -0.365 <0.001 Linear Regression-method : stepwise R=0.556 Stent length 0.284 0.001 K 0.273 0.001 C-dp/dtmax -0.200 0.014 Constant 18.512 0.037 Pre-PCI, post-PCI coronary CT, left ventricular pressure profile and coronary pressure profile in patients with coronary artery disease (Figure 3 ). Although the pre-procedure coronary CT cut-off was at the maximum diastolic volume, it was still larger than the optimal diastolic volume at 1-day post-procedure. It suggested that there was a decrease in diastolic function in the short post-procedure period. The left ventricular pressure curve (Figure 3 , D) showed that the left ventricular pressure was higher in the immediate post-procedure period than in the pre-procedure period, which means that diastolic function was reduced. One year after the procedure, the left ventricular pressure was measured again and showed an improvement in intraventricular pressure compared with the immediate post-procedure period and the pre-procedure period. Similarly, the coronary pressure curve (Figure 3 , E) showed a consistent change with the LV pressure curve, which means that diastolic function improved 1 year after the surgery compared with the immediate postoperative period and the preoperative period. For patients with LAD stents, T values before, immediately after and 1 year after the surgery showed a deterioration in diastolic function during the immediate postoperative period, but not for patients with LCX and RCA (Figure 4 , A), and the maximum rate of decrease in intracoronary pressure as a proxy for coronary artery compliance in patients with LAD. It was found that coronary artery compliance was consistent with a decrease in LV diastolic function and coronary artery compliance in the immediate postoperative period (Figure 4 , B). By grouping stent lengths, a correlation was found between T and stent length in patients with LAD implantation (Pearson R=0.437, P<0.01), whereas the correlation between T and stent length for patients with LCX and RCA implantation had no statistical significance (LCX: Pearson R=0.206, P=0.283, RCA: Pearson R =0.246, P=0.160) (Figure 5 , A); after grouping the stent lengths of patients with LAD stenting, a one-way ANOVA revealed statistically significant differences in T values between stent length groups (F=17.229, P<0.001), and a two-way comparison between the LAD, LCX and RCA groups revealed that the differences in T values in groups I, II and III had statistical significance. The difference between the LAD, LCX and RCA groups was statistically significant (LSD: P<0.01). The T value of the left ventricular diastolic function index increased with increasing stent length. The degree of deterioration of LVDF gradually increased (Figure 5 , B) Patients in group D were divided into groups, which were LAD single, two and three stent, according to the number of stents, with LAD two and three stents accounting for only 8.3% and 2.1% of the LAD implanted stents. A one-way ANOVA was applied to find that T values increased with the number of stents in each group, which means the differences in stent length and T-value were statistically significant in the different LAD groups (stent length F=147.408, P<0.001; T-value F=11.834, P<0.001) (Table 4 ), and there was a correlation between the increasement in T-value and stent length (Pearson R=0.546, P<0.001). The correlation is that the longer the stent length is, the greater the increasement in LV diastolic function after PCI is. The longer the stent length, the worse the LV diastolic function after PCI (Figure 5 , C). After grouping the T values in the LAD, 2LAD and 3LAD groups according to the upper limit of normal T values, a ROC curve was plotted to determine the optimal cut-off value of 24.5 mm for stent length (sensitivity 0.602, specificity 1.000, area under the curve 0.844, CI: 0.747-0.942, p<0.001) (Figure 6 ). Table 4 LAD single stent vs LAD multi-stent immediate post-operative data LAD 2LAD 3LAD P value ( n=129 ) ( n=12 ) ( n=3 ) Stent length 25.9(6.4) a 47.8(11.6) b 83.3(6.7) c <0.001 PFR 183.1(23.1) 186.3(22.2) 183.0(29.3) 0.900 T 47.6(3.8) a 51.7(2.7) b 55.5(1.7) b <0.001 K 5.9(0.2) a 6.2(0.1) b 6.2(0.1) b <0.001 LV+dp/dtmax 2477.0 (2446.4-2535.4) 2486.6 (2449.0-2554.7) 2463.7 (2437.1-2526.4) 0.698 LV-dp/dtmax 2295.6 (2243.9-2348.5) 2339.0 (2314.4-2381.6) 2285.9 (2275.3-2338.4) 0.115 CEDV 3.4(0.2) a 3.7(0.1) b 3.7(0.1) b <0.001 CESV 2.7(0.3) 2.8(0.2) 2.7(0.1) 0.857 Values are mean±standard deviation or median (interquartile spacing). K, stiffness index; LV+dp/dtmax, maximum rate of left ventricular pressure rise; LV-dp/dtmax, maximum rate of left ventricular pressure drop; CEDV, coronary artery end-diastolic volume; CESV, coronary artery end-systolic volume; C+dp/dtmax, maximum rate of coronary artery pressure rise; C-dp/dtmax, maximum rate of coronary artery pressure drop. Each subscript letter denotes a subset of categories whose row proportions do not differ significantly from each other at the .05 level. Discussion Diastolic heart failure is a common clinical syndrome. The prevalence is increasing because of an ageing population and increasing co-morbidity burden. More than half of patients with exertional dyspnea of unknown origin assessed invasively have diastolic heart failure, and more than 70% of heart failure patients over 65 years old have diastolic heart failure [ 19 – 21 ]. Left ventricular diastolic function plays an important role in the evaluation of clinical symptoms, treatment options and prognosis of patients with cardiovascular disease, and early and aggressive treatment of patients with diastolic dysfunction can prevent or delay the onset of heart failure [ 22 ]. In this study, coronary atherosclerosis and the implantation of stents during PCI caused a decrease in the compliance of the coronary arteries that travel on the surface of the heart, and the small blood vessels that distribute between the myocardium, resulting in a constricting effect on the heart and thus affecting diastolic function. The data were collected and analyzed from 540 PCI patients and the data showed that, excluding other factors, the diastolic function index T increased with age, and the diastolic function of patients decreased (Pearson R=0.696, P<0.001). Further grouped patients undergoing PCI showed that diastolic function decreased significantly in the immediate post-PCI period in patients with LAD lesions, whereas there was no significant decrease in diastolic function in patients with LCX and RCA lesions. With the number of stents implanted increased, T values also increased. The total length of the stent implanted was positively correlated with the T value, which shows that the longer the length of the stent implanted is, the worse the patient's diastolic function in the immediate postoperative period is. But when coronary angiography was repeated 1 year after stent implantation, the T value of the patient's left ventricular diastolic function was found to have recovered. The degree of coronary artery disease has been shown to correlate with left ventricular diastolic function [ 6 , 23 , 24 ]. A foreign clinical study investigated the relationship between the degree of coronary stenosis and left ventricular diastole by using non-invasive coronary CT, with an increase in LVEDP of 0.8 mmHg for every 0.05-1.1 increase in coronary segmental stenosis score [ 7 ], suggesting a decrease in left ventricular compliance due to myocardial ischemia because of insufficient coronary blood supply. Coronary atherosclerosis is caused by the accumulation of LDL to form lipid plaques, and the narrowing and narrowing of the lumen is accompanied by a hardening and loss of elasticity of the vessel wall. In this study, the degree of coronary artery disease was found to be involved in diastolic insufficiency through myocardial ischemia. The results show that coronary artery disease and the changes in ischemia and hypoxia in the small vessels it affects can cause a decreasement in diastolic function, and that the more severe the coronary artery disease is, the worse the diastolic function is. And coronary atherosclerosis may reduce the compliance of the coronary arteries and thus have a restraining effect on the contraction and diastole of the heart. Atherosclerosis of the coronary arteries can reduce the elasticity of the vessels and have a constricting effect on the heart, theoretically resulting in a reduction in diastolic function. It was found by this study that the change in LV diastolic function was mainly affected by LAD and its small vessel lesions. And what is more, the more severe the LAD lesion is, the worse the diastolic function in the absence of external intervention is. One year after stent implantation, the patient's left ventricular function basically returned to normal after one year as the stent opened the vessel and as the coronary vessels adapted to the stent allowing vascular compliance to return, thus restoring the blood and oxygen supply to the ventricles. Previous studies have done some comparison on LVEF for patients undergoing PCI using echocardiography before, 1 day after and 3-6 months after the procedure. It was found that LVEF improved significantly at 1 day and 3-6 months after the procedure, whereas diastolic function improved at 1 day but did not change 3-6 months after the procedure [ 25 ]. Other studies have shown that LV diastolic function is altered after PCI [ 26 – 28 ]. These studies have used non-invasive tests and have small sample sizes. The present studies used the left ventricular isovolumic relaxation time constant T, which is less affected by other factors, to represent left ventricular diastolic function using an invasive catheter method and therefore, it could be more accurately to reflect the changes in left ventricular diastolic function for patients after surgery[ 13 ]. This study had some limitations. First, the patients selected were limited to Fengxian District Central Hospital and not randomly selected patients across the country; second, the study was retrospective and not prospective. Therefore, the effect of stent length and stent implantation site on post-PCI needs to be further investigated. Conclusion In this study, by comparing patients with different degrees of coronary artery stenosis, it was verified that coronary atherosclerosis can lead to a decrease in compliance of the coronary arteries travelling on the surface of the heart and the small vessels distributed between the myocardium, and it was also found that as the degree of coronary stenosis increased, LV diastolic function gradually decreased; and by further investigation, it was found that the degree of LAD vessel lesion and the LAD stent implantation It was also found that the degree of LAD vessel disease and the length of LAD stent implantation were closely related to the degree of reduction in LV diastolic function. The discovery could provide new clinical ideas for active intervention in postoperative patients with cardiovascular events such as diastolic insufficiency, and also provide some clinical evidence to help clinicians better judge the application of stents in patients who need to undergo PCI length. Abbreviations LVDF: Left ventricular diastolic function CHD: Coronary heart disease LAD: Left anterior descending artery LCX: Left circumflex artery RCA: Right coronary artery LVDD: Left ventricular diastolic dysfunction PCI: Percutaneous coronary intervention NYHA: New York Heart Association K: Left ventricular stiffness index DPV: Diastolic-Pressure-Volume Curve CEDV: End-diastolic coronary volume CESV: End-systolic coronary volume C+dp/dtmax: Maximum rate of increase in coronary pressure C-dp/dtmax: Maximum rate of decrease in coronary pressure CAG: Coronary angiography LVEDV: Left ventricular end-diastolic volume LVESV: Left ventricular end-systolic volume LVEF: Left ventricular ejection fraction LV+dp/dtmax: Maximum rate of left ventricular pressure rise LV-dp/dtmax: Maximum rate of left ventricular pressure fall PFR: Maximum left ventricular filling rate T: Time constant of relaxation Declarations Ethics approval and consent to participate All included patients gave their oral and written informed consent. The study was approved by the Ethics Committee (full name: the Shanghai Fengxian District Central Hospital Medical Ethics Committee)(reference number: 2014-KY-06) to Department of Cardiology, Fengxian Branch of Shanghai 6 th People’s Hospital, Shanghai , China Consent for publication Not applicable. Data availability statements The data that support the findings of this study are not openly available due to human data and are available from the corresponding author upon reasonable request. Sources of Funding This work was funded by the Shanghai Municipal Health Commission, China (No.202140493) and the Shanghai Science and Technology Committee of Shanghai, China (No.17411969400) Author Contribution Jiangwei Ma conceived of and designed the experiments. Liang Lv and Yanan Xu performed the experiments. Liang Lv analyzed the data. Liang Lv and Shanshan Kan prepared the figures and wrote the manuscript. Qiong Zhang, Xiaomin Chen, Huajin Liu, Hongwei Wang and Changhua Wang revised the manuscript. All authors read and approved the final manuscript. Disclosures The authors declare that they have no competing interests. Acknowledgments The authors would like to thank Dr. Kangjian Zhang for helpful discussions on topics related to this work. Additional information The Chinese Society of Interventional Cardiology and Chinese Society of Cardiology are different. And all methods were carried out in accordance with relevant guidelines and regulations or according to Declaration of Helsinki. References Musunuru, K. and S. Kathiresan, Genetics of Common, Complex Coronary Artery Disease. Cell, 2019. 177(1): p. 132–145. Pagliaro, B.R., et al., Myocardial ischemia and coronary disease in heart failure. Heart Failure Reviews, 2020. 25(1). Wojciech, et al., Relation Between Heavy Metals and Left Ventricular Diastolic Function in Patients with Coronary Artery Disease. Toxicology Mechanisms and Methods, 2008. 14(3): p. 177–182. Jamiel, A., et al., 38. Is there a correlation between diastolic dysfunction and coronary artery disease on coronary CT angiography? Heart Views the Official Journal of the Gulf Heart Association, 2016. 17(1): p. 13-18. Rtaqueti, V., et al., Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. European Heart Journal: The Journal of the European Society of Cardiology, 2018. Shah, S.J., et al., Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. European Heart Journal, 2018(37): p. 37. Lin, F.Y., et al., Extent and severity of coronary artery disease by coronary CT angiography is associated with elevated left ventricular diastolic pressures and worsening diastolic function. Journal of Cardiovascular Computed Tomography, 2013. 7(5): p. 289-296.e1. Roos, C.J. and D. Auger, Relationship between left ventricular diastolic function and arterial stiffness in asymptomatic patients with diabetes mellitus. International Journal of Cardiovascular Imaging, 2013. 29(3): p. 609–616. Neumann, F.J., et al., 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 2019. 40(2). Kim, E.K., et al., Prognostic Implications of Diastolic Dysfunction Change in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Circulation Journal, 2019. 83(9). Nozari, Y., N.J. Oskouei and Z. Khazaeipour, Effect of Elective Percutaneous Coronary Intervention on Left Ventricular Function in Patients with Coronary Artery Disease. Acta Medica Iranica, 2012. 50(1): p. 26–30. Gensini, G.G., A more meaningful scoring system for determining the severity of coronary heart disease. American Journal of Cardiology, 1983. 51(3): p. 606–606. Weiss, J.L., J.W. Frederiksen and M.L. Weisfeldt, Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. Journal of Clinical Investigation, 1976. 58(3): p. 751–760. Gupta, H., et al., Left Ventricular Torsion Shear Angle Volume Approach for Noninvasive Evaluation of Diastolic Dysfunction in Preserved Ejection Fraction. Journal of the American Heart Association, 2018. 7(11): p. 1442. Yotti, R., et al., Noninvasive estimation of the rate of relaxation by the analysis of intraventricular pressure gradients. Circ Cardiovasc Imaging, 2011. 4(2): p. 94–104. Yoshizane, T., et al., Validation by Cardiac Catheterization of Noninvasive Estimation of Time Constant of Left Ventricular Pressure Decline as an Index of Relaxation by Speckle Tracking Echocardiography. American Journal of Cardiology, 2018: p. S0002914918302972. Schertel, E.R., Assessment of left-ventricular function. Thoracic & Cardiovascular Surgeon, 1998. 46(S 2): p. 248–254. Ngiam, J.N., et al., Novel Echocardiography-Derived Left Ventricular Stiffness Index in Low-Flow Versus Normal-Flow Severe Aortic Stenosis with Preserved Left Ventricular Ejection Fraction. Scientific Reports, 2020. 10(1): p. 9086. Reddy, Y.N.V., et al., A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation, 2018: p. CIRCULATIONAHA.118.034646. Shah, A.M., et al., Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study. Circulation, 2016: p. 224. Chang, P.P., et al., Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005-2014): The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance. Circulation, 2018: p. CIRCULATIONAHA.117.027551. Ren, X., et al., Prevalence and prognosis of asymptomatic left ventricular diastolic dysfunction in ambulatory patients with coronary heart disease. American Journal of Cardiology, 2007. 99(12): p. 1643–1647. Miyoshi, T., et al., Cardio-Ankle Vascular Index is Independently Associated with the Severity of Coronary Atherosclerosis and Left Ventricular Function in Patients with Ischemic Heart Disease. Journal of atherosclerosis and thrombosis, 2010. 17(3): p. 249–258. Multiple common comorbidities produce left ventricular diastolic dysfunction associated with coronary microvascular dysfunction, oxidative stress, and myocardial stiffening. Cardiovascular Research, 2018. Salehi, N., et al., Effect of Percutaneous Coronary Intervention on Left Ventricular Diastolic Function in Patients With Coronary Artery Disease. Global Journal of Health Science, 2016. 8(1): p. 270–276. Lehtinen, M., et al., Combining FDG-PET and 99mTc-SPECT to predict functional outcome after coronary artery bypass surgery. European Heart Journal - Cardiovascular Imaging, 2015. Reza, H.S., et al., Evaluation of the Effect of Elective Percutaneous Coronary Intervention as a Treatment Method on the Left Ventricular Diastolic Dysfunction in Patients with Coronary Artery Disease. Journal of Tehran Heart Center, 2010. 5(4): p. 194–198. Hoebers, L.P., et al., Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. International Journal of Cardiology, 2015. 187: p. 90–96. Additional Declarations No competing interests reported. Supplementary Files SupplementalMaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 29 Mar, 2022 Reviewers agreed at journal 03 Mar, 2022 Reviews received at journal 03 Mar, 2022 Reviewers agreed at journal 20 Feb, 2022 Reviewers invited by journal 16 Feb, 2022 Editor assigned by journal 16 Feb, 2022 Editor invited by journal 03 Feb, 2022 Submission checks completed at journal 03 Feb, 2022 First submitted to journal 22 Jan, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1287458","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":81166709,"identity":"68ccbfa1-40ca-4594-9462-ef67fd9dbfb7","order_by":0,"name":"Liang Lv","email":"","orcid":"","institution":"Southern Medical University, Southern Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Lv","suffix":""},{"id":81166710,"identity":"78727d5d-5e69-42cf-88e6-cc2e5fe83761","order_by":1,"name":"Yannan Xu","email":"","orcid":"","institution":"Anhui University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yannan","middleName":"","lastName":"Xu","suffix":""},{"id":81166711,"identity":"7e597e7a-1fdf-43e5-9bcd-631af2d5776e","order_by":2,"name":"Qiong Zhang","email":"","orcid":"","institution":"Fengxian Branch of Shanghai 6 th People’s Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qiong","middleName":"","lastName":"Zhang","suffix":""},{"id":81166712,"identity":"0a88dd26-b8ee-48e8-b005-268829e8d9e8","order_by":3,"name":"Shanshan Kan","email":"","orcid":"","institution":"Anhui University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"Kan","suffix":""},{"id":81166713,"identity":"efa14490-4750-4dda-b2a6-f44753ab8b61","order_by":4,"name":"Xiaoming Chen","email":"","orcid":"","institution":"Anhui University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoming","middleName":"","lastName":"Chen","suffix":""},{"id":81166714,"identity":"c4927ca2-6987-492b-8337-5d48884e71b1","order_by":5,"name":"Huajin Liu","email":"","orcid":"","institution":"Fengxian Branch of Shanghai 6 th People’s Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huajin","middleName":"","lastName":"Liu","suffix":""},{"id":81166715,"identity":"aa87916a-8fdb-463f-a7da-88bd90f14320","order_by":6,"name":"Hongwei Wang","email":"","orcid":"","institution":"Fengxian Branch of Shanghai 6 th People’s Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Wang","suffix":""},{"id":81166716,"identity":"263c66b2-647b-4ebe-8b76-3aadb3363cf5","order_by":7,"name":"Changhua Wang","email":"","orcid":"","institution":"TengZhou City Central People Hospital, Affiliated to Jining Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Changhua","middleName":"","lastName":"Wang","suffix":""},{"id":81166717,"identity":"89d837dd-a9cc-4a04-80d9-49267cab41b8","order_by":8,"name":"M. D. Jiangwei Ma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIie2RsWrDQAyG7ziwFx1ZE+w+QqEhkMk0fRSZQCbnDdrUYLguKVkd+hKZSrfKHCSLqVdDFvcBCvbYoaVHpy49Zyz0vkEC8X8IIcYcjr8J0ncTggghgoGfnqx4cdOGi3C0ppO3wWScRzq6qK/sufM7eqX3p5t447NpAEkFrGa87ZLflWmJWNyXh3ibsUUA5RH4QypG20eLQogk1X6502wfyPURREiekDalarD4MMqz5iqQny/gDbFHqRG1VNfLnRBinAMB9CsN6jNFt7n2eNPCHIZQZPZbqmTevanVZLCpWvPKy9nskBVtZ1HMO9AU/XPCU1ve4JMpq56Qw+Fw/Gu+ACnUW3qFX8gnAAAAAElFTkSuQmCC","orcid":"","institution":"Fengxian Branch of Shanghai 6 th People’s Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"M.","middleName":"D. Jiangwei","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2022-01-23 00:29:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1287458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1287458/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":18009172,"identity":"40c8ba78-7921-43de-ace6-001c59b208a7","added_by":"auto","created_at":"2022-02-07 19:03:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":122571,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy design and patients.\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA: control group, B: coronary artery atherosclerosis group, C: coronary artery atherosclerotic heart disease group, D: PCI group.\u003c/p\u003e","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/01f2e1ac53a48d9283ddda64.png"},{"id":18009251,"identity":"8fe8286b-4134-4943-a131-e09785e4278a","added_by":"auto","created_at":"2022-02-07 19:06:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20759,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation between age and T in the A group.\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe effect of age on diastolic function was explored by grouping patients in the control group by age. A one-way ANOVA on the five groups showed F=13.893, p\u0026lt;0.001; multiple comparisons showed no statistically significant difference in T-values between groups 2 and 3 (p=0.714); the remaining groups showed statistically significant differences.\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/cdaece9749b04c2fb25ffb58.png"},{"id":18009252,"identity":"be93e13d-e999-4165-970f-8041ae15e739","added_by":"auto","created_at":"2022-02-07 19:06:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":269168,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of coronary CT, left ventricular pressure profile and coronary pressure profile data before and after PCI in a patient with coronary artery disease.\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe patients treated with PCI intervention, whose left ventricular pressure as well as coronary pressure profiles were preserved and coronary CT was performed to obtain a more comprehensive data on the patient's left ventricular diastolic function.\u003c/p\u003e\u003cp\u003e(A) Coronary Artery CT was performed Preoperatively.\u003c/p\u003e\u003cp\u003e(B) Coronary Artery CT was Performed 1 Day after Surgery.\u003c/p\u003e\u003cp\u003e(C) Coronary Artery CT was Performed 1 Year after Surgery.\u003c/p\u003e\u003cp\u003e(D) Left Ventricular Pressure Curve. ① represents pre-procedure period,\u0026nbsp;② represents the immediate post-procedure period, ③ represents one year after the procedure\u003c/p\u003e\u003cp\u003e(E) Coronary Pressure Curve. ④ represents pre-procedure period, ⑤ represents the immediate post-procedure period, ⑥ represents one year after the procedure\u003c/p\u003e","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/7809a825042250fc6eb7534d.png"},{"id":18008987,"identity":"3c7df951-c74e-477d-be35-44306c26cb4b","added_by":"auto","created_at":"2022-02-07 19:00:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":52239,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSingle stent-LV diastolic function and coronary artery compliance.\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e(A) We recorded T values from patients with LAD, LCX and RCA single stent implantation before, immediately after and one year after the procedure and used line graphs to visualize the relationship between T values and stenting site. \u003c/p\u003e\u003cp\u003e(B) The maximum rate of coronary pressure drop in the immediate postoperative period in patients with LAD stenting was selected as an indicator of coronary artery compliance and thus compared to an indicator of left ventricular diastolic function.\u003c/p\u003e","description":"","filename":"fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/8b8c6f05145a93be0b02f384.png"},{"id":18008992,"identity":"202ffeae-cf6c-4cb9-91dd-3e12f3b9bc1c","added_by":"auto","created_at":"2022-02-07 19:00:26","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":75864,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe correlation between T and stent length.\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e(A) To investigate the relationship between stent length and T at different implantation sites and whether there are differences between implantation sites. And T-values are measured in the immediate post-operative period\u003c/p\u003e\u003cp\u003e(B) Patients with LAD stents were divided into three groups according to the length of the stent, using a cut-off of 24mm and 36mm, in order to visualize the change in T values between these groups. T-values are measured in the immediate post-operative period\u003c/p\u003e\u003cp\u003e(C) The total stent length was calculated for each patient with LAD implanted stent. Patients with LAD, 2LAD, and 3LAD were divided into three groups using a 24mm and 36mm stent length cut-off to visualize the relationship between T and stent length. T-values are measured in the immediate post-operative period\u003c/p\u003e","description":"","filename":"fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/1d274b37852d99a3b57ce5c5.png"},{"id":18008989,"identity":"ed2c2ba9-b45b-4405-a944-fef0f4bdb6ad","added_by":"auto","created_at":"2022-02-07 19:00:26","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":21655,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve.\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe upper limit of normal values of T was used as a cut-off for the group. And patients with LAD stents were divided into normal and abnormal groups. The T values of both groups were analysed by ROC curves to determine the threshold length of the stent that could cause abnormal T values in LAD implanted stents.\u003c/p\u003e","description":"","filename":"fig6.png","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/1433c492752e8a40c382170f.png"},{"id":18009253,"identity":"a8b38de7-67a6-4e23-b149-f9697288fc8e","added_by":"auto","created_at":"2022-02-07 19:06:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":762646,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/4ca6339e-5c17-4469-a1a0-e4073745f186.pdf"},{"id":18008993,"identity":"d8f1610f-c5c8-428e-9243-7ced95609563","added_by":"auto","created_at":"2022-02-07 19:00:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1288220,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-1287458/v1/d5d05870e29e72e2d3591105.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, coronary artery atherosclerotic heart disease has caused an increasement in morbidity and mortality rate and is the leading cause of death worldwide[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Several studies have shown that coronary artery disease could cause structural remodeling of the left ventricle, adversely affecting left ventricular diastole and myocardial stiffness leading to reduced left ventricular diastole and increased stiffness, which in turn increases cardiac filling pressures and diastolic insufficiency prior to ventricular systolic dysfunction[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Left ventricular diastolic dysfunction (LVDD), which occurs in up to 34% of patients with coronary artery disease, is closely associated with myocardial ischemia and has been shown to alter its clinical course[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Non-obstructive coronary sclerotic plaques are not sufficient to cause myocardial ischemia but can promote alterations in vascular tone function and may also alter LVDF[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], while it has been suggested that preventing the development of atherosclerosis may help to reduce the incidence of LVDD in the diabetic population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], suggesting that coronary sclerosis may be involved in the development of LVDD independently of myocardial ischemia affecting vascular elasticity. Atherosclerosis of the coronary arteries, which travel on the surface of the heart, and the rich network of capillaries distributed between the myocardium, are essential for the supply of blood to the myocardium. And atherosclerosis of the coronary arteries leads to a decrease in vascular elasticity, which has a constricting effect on the heart like that of myocardial fibrosis on the ventricular wall. The effect theoretically also causes a decrease in myocardial diastolic function. Previous studies have focused on the reduction in active and passive diastolic function due to ischemic factors but less on coronary atherosclerosis.\u003c/p\u003e \u003cp\u003ePCI is currently the choice of treatment for patients with coronary artery disease who have severe stenosis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. One study showed that half of patients\u0026rsquo; diastolic function improved in 3-4 years after PCI, while diastolic function remained unchanged or worsened in the remaining patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; another study showed an improvement in left ventricular diastolic function 3 months after stenting [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], suggesting that PCI may affect LVDF in patients, but these studies did not further investigate if the reduced coronary artery compliance caused by stenting influences LVDF.\u003c/p\u003e \u003cp\u003eTherefore, it is necessary to investigate if coronary atherosclerosis and the reduced compliance of coronary arteries and small vessels distributed between the myocardium caused by the implantation of stents during PCI could cause a certain constricting effect on the heart and thus affect the diastolic function of the heart, so that the changes in diastolic function in patients undergoing PCI with stents can be investigated and appropriate therapeutic measures can be taken in a timely and rapid manner to delay or prevent the onset of left ventricular diastolic insufficiency.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eStudy Design and Patients\u003c/h2\u003e\n \u003cp\u003eInclusion subjects: From October 2016 to October 2019, 581 patients diagnosed with CHD in the Department of Cardiology, Fengxian District Central Hospital, of which 318 patients underwent PCI (Figure 1), were selected under a retrospective study. All enrolled patients signed an informed consent form, and the study was approved by the Ethics Committee of the Sixth People\u0026apos;s Hospital of Shanghai Jiao Tong University South Hospital.\u003c/p\u003e\n \u003cp\u003eInclusion criteria: (1) the diagnostic criteria for unstable angina referred to the 2007 release of the Chinese Society of Cardiovascular Diseases; (2) the age was controlled from 18 to 75 years old; (3) Doppler ultrasound examination was performed within 3 days before PCI and 1 year after the repeat imaging, and the left ventricular ejection fraction was greater than 50%; (4) complete clinical data; (5) no history of iodine allergy.\u003c/p\u003e\n \u003cp\u003eExclusion criteria: (1) patients with a combined history of acute myocardial infarction or old myocardial infarction; (2) various organic heart diseases such as rheumatic heart valve disease, cardiomyopathy, myocardial amyloidosis, ventricular wall tumor, congenital heart disease and pericardial disease as suggested by cardiac ultrasound; (3) patients with heart failure of New York Heart Association (NYHA) cardiac function class III or above; (4) patients with chronic obstructive pulmonary disease (5) patients with atrial fibrillation; (6) patients with chronic underlying diseases such as severe hepatic or renal insufficiency or severe anemia; (7) patients requiring repeat PCI; and (8) patients with co-infectious diseases.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2 class=\"Heading\"\u003eCoronary Angiography and Intervention\u003c/h2\u003e\n\u003cp\u003eCoronary angiography and stenting were performed using standard interventional techniques according to the practice guidelines established by the Chinese Society of Interventional Cardiology. Cardiac catheterization and hemodynamic measurements were performed using a large C-wall digital subtraction X-ray system (Model: AXIOM Artis Zee Celling, Device serial number: 147191, Device identification number: 720-939180) and its matching polysomnography. Coronary angiography was performed by an experienced associate chief cardiologist or above, using multiple projections. And two experienced cardiac catheterists quantitatively evaluated the presence or absence of stenosis and vascular stenosis, selected for stent implantation according to the degree of coronary lesion, and collected the length and number of stents in patients with stent implantation. The successful PCI refers to: residual coronary stenosis \u0026lt;10% after stent implantation, and visualized after angiography Assessment without significant intimal tears, distal embolism, coronary slow flow, occluded side branch occlusion. Gensini scoring method: all patients were scored for each patient\u0026apos;s coronary lesion using the modified Gensini score under American Heart Association criteria [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003ch2\u003eDF Measurement and Analysis\u003c/h2\u003e\n\u003cp\u003eLeft ventriculography: Patients were instructed to assume a right anterior oblique position, photographed at a 30\u0026deg; angle and the contrast agent iodixanol was injected at a certain rate using a high-pressure syringe, with 50 frames/s as the filming speed for coronary angiography in patients with coronary artery disease. Measurements were made according to the playback. The electrocardiogram, left ventricular pressure curve and aortic pressure curve are also recorded simultaneously for at least 5 consecutive cardiac cycles.\u003c/p\u003e\n\u003cp\u003eMeasurement of left ventricular diastolic function indicators: maximum left ventricular filling rate (PFR), maximum rate of left ventricular pressure rise (LV+dp/dtmax) and maximum rate of left ventricular pressure fall (LV-dp/dtmax), systolic+dp/dtmax and diastolic-dp/dtmax, and left ventricular isovolumic diastolic relaxation are measured according to the left ventricular pressure curve using a pressure guidewire system. Time constant of relaxation (T, normal value is \u0026lt;40 ms) refers to the time between the peak dp/dt and the end-diastolic pressure of the left ventricle.\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec6\"\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e \u0026Delta;\u003cem\u003eP\u003c/em\u003e = \u003cem\u003eP\u003c/em\u003e\u003csub\u003eu\u003c/sub\u003e - \u003cem\u003eP\u003c/em\u003e\u003csub\u003el\u003c/sub\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e( P\u003csub\u003eu\u003c/sub\u003e, Pressure upper limit; P\u003csub\u003el\u003c/sub\u003e, Pressure lower limit; t, time of pressure changes between P1 and P2)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe inverse of the slope of this line is T, which reflects active left ventricular diastolic function [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. The left ventricular stiffness index (K) is obtained by approximating the Diastolic-Pressure-Volume Curve (DPV) using the data points collected at the end of diastole. The tangent slope of any point on this curve (dP/dV) is called the left ventricular lumen stiffness. And K is the slope of the linear relationship between ventricular stiffness and ventricular pressure, reflecting left ventricular Passive diastolic function [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Coronary pressure was measured by end-diastolic coronary volume (CEDV), end-systolic coronary volume (CESV), maximum rate of increase in coronary pressure (C+dp/dtmax). Maximum rate of decrease in coronary pressure(C-dp/dtmax) were measured using pressure guidewires as described above. The coronary angiography (CAG) was reviewed in all patients from 9 months to 1 year after stenting, and indicators reflecting cardiac volumes, size and left ventricular systolic and diastolic function were collected.\u003c/p\u003e\n \u003cp\u003eCoronary 64-layer spiral CT: A retrospective cardiac gated spiral scan was performed using a Philips Brilliance 64-layer CT machine to select an appropriate scan protocol. After the scan, 20 (5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 95%, 100%) ECGs were obtained by automatic offline reconstruction using 5% intervals with a reconstruction layer thickness of 1.5 mm and a spacing of 1.0 mm, Kemal value (convolution value) B26f. (90%, 95%, 100%) cardiac cycles. The reconstructed images were transferred to the Syngo workstation, and the 5%-100% full-phase images were transferred to the Circulation software for analysis of cardiac function. 21 time-phase reconstructions were transferred to the post-processing workstation, where two experienced image physicians were selected to perform post-processing and calculate left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular systolic volume (LVESV). end-diastolic volume (LVEDV), left ventricular systolic volume (LVESV), maximum rate of left ventricular pressure rise (LV+dp/dtmax), maximum rate of left ventricular pressure fall (LV-dp/dtmax), maximum left ventricular filling rate (PFR), and left ventricular ejection fraction (LVEF).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eBaseline demographic data and clinical variables were summarized with continuous variables and expressed as mean \u0026plusmn; standard deviation or median with interquartile range. Categorical data were expressed as percentages and number of events. ANOVA or Kruskal-Wallis non-parametric tests for continuous variables as applicable, and \u0026chi;2 tests for categorical data were used to compare if there were differences in LVDF among groups. All analyses used SPSS software version 25.0. The statistical significance of all the analyses was drawn at a 2-sided significance level, which was 0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e540 patients treated with PCI were analyzed by a complete data set including LV diastolic function assessed at baseline and follow-up (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The four groups of patients aged 63.0 \u0026plusmn; 9.5 years old and 47.8% of them were male. Patients in group D had higher blood cholesterol, blood creatinine and BNP compared with those in group A. Control patients were selected and grouped by an age interval of 10: group 1 (45 \u0026le; age \u0026lt; 55), group 2 (55 \u0026le; age \u0026lt; 65), group 3 (65 \u0026le; age \u0026lt; 75), group 4 (75 \u0026le; age \u0026lt; 85),group 5 (85 \u0026le; age) ( A statistically significant difference (F=13.893, p\u0026lt;0.001) was found that the T values of patients in the different age groups were of statistical values with an increase in the T value of the corresponding diastolic function index as the age of the patients increased (Figure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e); also, a one-way ANOVA of the Gensini scores of patients in groups B, C and D showed a statistically significant difference (p\u0026lt;0.001). As the degree of coronary artery disease increased, a comparison of DT and LAD measured by echocardiography and T values measured by invasive catheterization, which more accurately reflect the diastolic function of the left ventricle, revealed that patients in groups C and D where the degree of coronary stenosis was greater than 50%, showed a more significant decrease in diastolic function than patients in groups A and B. Patients in group D had poorer diastolic function than those in group C. Correlation analysis of patients in group D with T as the dependent variable showed a correlation between T and Gensini score and C-dp/dtmax (Pearson R=0.696, -0.540, p\u0026lt;0.001) and multiple linear regression analysis showed a linear correlation between T and Gensini score and C-dp/dtmax (R=0.711, B=0.575, -0.197, p\u0026lt;0.001). 0.711, B=0.575, -0.197, P\u0026lt;0.001). As the degree of coronary atherosclerosis increased, the patient\u0026apos;s left ventricular diastolic function also progressively decreased.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline Characteristics of the Study Patients With CAD Undergoing PCI\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=97 )\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=114 )\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=52 )\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n=318)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33(63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.6(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.6(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.8(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.4(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBSA, m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.77(0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.78(0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.78(0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.73(0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoker (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125(39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e200(62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54(17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum\u0026nbsp;cholesterol, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.6(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFasting\u0026nbsp;glucose, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.20\u003c/p\u003e\n \u003cp\u003e(5.16-7.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.05\u003c/p\u003e\n \u003cp\u003e(5.60-7.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003cp\u003e(5.35-7.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u003c/p\u003e\n \u003cp\u003e(4.53-7.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum triglyceride, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003cp\u003e(0.72-2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003cp\u003e(0.94-1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003cp\u003e(0.93-1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003cp\u003e(0.93-2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum\u0026nbsp;creatinine, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003cp\u003e(49.5-70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.0\u003c/p\u003e\n \u003cp\u003e(52.0-71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.0\u003c/p\u003e\n \u003cp\u003e(66.0-89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003cp\u003e(56.4-92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBNP, ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003cp\u003e(23.9-55.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003cp\u003e(28.8-71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003cp\u003e(22.7-50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115.0\u003c/p\u003e\n \u003cp\u003e(23.7-269.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGensini score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003cp\u003e(2.5-5.0)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003cp\u003e(10.0-17.25)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003cp\u003e(33.2-43.6)\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eAngiographic and procedural findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDT, ms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169.1(61.8)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e189.8(43.4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e217.2(39.1)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235.7(79.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.1(4.8)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.5(5.2)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.3(4.6)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.5(9.1)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAD, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.8(2.9)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.0(3.3)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.1(4.9)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.1(6.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eE/e\u0026apos;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.4(0.8)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.9(1.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.3(1.4)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.6(2.2)\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePFR, ml/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e264.9(19.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e242.3(27.9)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e227.2(21.8)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e203.3(14.8)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT, ms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.0(7.6)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.0(5.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5(6.3)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.2(3.8)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eA: control group, B: coronary artery atherosclerosis group, C:coronary artery atherosclerotic heart disease group, D: PCI group. Values are mean\u0026plusmn;standard deviation or n (%). BSA, body surface area; LDL, low-density lipoprotein; HDL, high-density lipoprotein; BNP, brain natriuretic peptide; DT, deceleration time (ms); EF, ejection fraction (%); LAD, anteroposterior diameter of left atrium; PFR, peak early filling rate; T, time constant of relaxation. Each subscript letter denotes a subset of categories whose row proportions do not differ significantly from each other at the .05 level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAccording to the stent implantation site, patients in Group D were divided into LAD, LCX and RCA groups and further investigated for changes in diastolic function indices preoperatively, immediately postoperatively and 1 year postoperatively. Among the patients with single stents, those with LAD stents got lower preoperative PFR indexes than those with LCX and RCA stents while T, K, LV+dp/dtmax and LV-dp/dtmax indexes were significantly higher than thoses with LCX and RCA stents, and the differences were statistically significant (P\u0026lt;0.001). T, K, LV+dp/dtmax and LV-dp/dtmax were higher than those before surgery and the difference was of statistical significance. Diastolic function decreased further, and diastolic function indicators gradually recovered after 1 year postoperatively (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The correlation between T and stent length, Gensini score, ventricular stiffness, LV-dp/dtmax, CEDV, CESV and C-dp/dtmax was statistically significant, while multiple linear regression with T as the dependent variable revealed that stent length, C-dp/dtmax and ventricular stiffness were statistically significant (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLAD single stent - left ventricular diastolic function data\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLAD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLCX\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRCA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n=129)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=29 )\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=34 )\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-PCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198.3(8.8)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225.4(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225.2(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8(3.7)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.6(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.9(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9(0.6)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.3(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2305.7\u003c/p\u003e\n \u003cp\u003e(2257.1-2364.4)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2012.5\u003c/p\u003e\n \u003cp\u003e(2005.2-2027.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2005.3\u003c/p\u003e\n \u003cp\u003e(1973.0-2049.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2207.5\u003c/p\u003e\n \u003cp\u003e(2166.6-2247.5) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1899.0\u003c/p\u003e\n \u003cp\u003e(1888.7-1911.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1903.1\u003c/p\u003e\n \u003cp\u003e(1893.7-1919.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCEDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8(0.1)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCESV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1941.4(360.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2089.2(104.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2077.4(65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1680.1(250.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1753.1(81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1749.1(54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eIM-post-PCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStent length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.9(6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.5(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.6(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183.1(23.1)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e226.0(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225.8(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.5(4.0)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.5(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.7(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9(0.2)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2477.0\u003c/p\u003e\n \u003cp\u003e(2446.4-2535.4)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2026.2\u003c/p\u003e\n \u003cp\u003e(1998.9-2088.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2010.7\u003c/p\u003e\n \u003cp\u003e(1972.4-2054.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2295.6\u003c/p\u003e\n \u003cp\u003e(2243.9-2348.5)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1903.5\u003c/p\u003e\n \u003cp\u003e(1890.9-1921.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1906.0\u003c/p\u003e\n \u003cp\u003e(1891.1-1930.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCEDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4(0.1)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCESV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7(0.3)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1747.7(365.6)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2087.2(111.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2068.1(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1495.0(259.9)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1753.9(82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1747.9(53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-PCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222.5(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225.4(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225.2(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.986\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.6(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.6(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2075.0\u003c/p\u003e\n \u003cp\u003e(1881.9-2225.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2068.5\u003c/p\u003e\n \u003cp\u003e(1974.9-2117.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2010.5\u003c/p\u003e\n \u003cp\u003e(1969.5-2059.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1872.6\u003c/p\u003e\n \u003cp\u003e(1731.0-2019.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1897.4\u003c/p\u003e\n \u003cp\u003e(1834.6-1928.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1899.0\u003c/p\u003e\n \u003cp\u003e(1864.7-1958.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCEDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCESV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2097.0(311.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2091.4(134.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2080.9(118.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1828.7(224.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1756.2(151.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1765.8(120.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eValues are mean\u0026plusmn;standard deviation or median (interquartile spacing). K, stiffness index; LV+dp/dtmax, maximum rate of left ventricular pressure rise; LV-dp/dtmax, maximum rate of left ventricular pressure drop; CEDV, coronary artery end-diastolic volume; CESV, coronary artery end-systolic volume; C+dp/dtmax, maximum rate of coronary artery pressure rise; C-dp/dtmax, maximum rate of coronary artery pressure drop. \u0026apos;*\u0026apos;indicates that the difference is statistically significant in the same row.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation of T and clinical parameters.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003estent length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGensini score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCEDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCESV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eLinear Regression-method : stepwise R=0.556\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStent length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePre-PCI, post-PCI coronary CT, left ventricular pressure profile and coronary pressure profile in patients with coronary artery disease (Figure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Although the pre-procedure coronary CT cut-off was at the maximum diastolic volume, it was still larger than the optimal diastolic volume at 1-day post-procedure. It suggested that there was a decrease in diastolic function in the short post-procedure period. The left ventricular pressure curve (Figure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, D) showed that the left ventricular pressure was higher in the immediate post-procedure period than in the pre-procedure period, which means that diastolic function was reduced. One year after the procedure, the left ventricular pressure was measured again and showed an improvement in intraventricular pressure compared with the immediate post-procedure period and the pre-procedure period. Similarly, the coronary pressure curve (Figure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, E) showed a consistent change with the LV pressure curve, which means that diastolic function improved 1 year after the surgery compared with the immediate postoperative period and the preoperative period.\u003c/p\u003e\n\u003cp\u003eFor patients with LAD stents, T values before, immediately after and 1 year after the surgery showed a deterioration in diastolic function during the immediate postoperative period, but not for patients with LCX and RCA (Figure \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, A), and the maximum rate of decrease in intracoronary pressure as a proxy for coronary artery compliance in patients with LAD. It was found that coronary artery compliance was consistent with a decrease in LV diastolic function and coronary artery compliance in the immediate postoperative period (Figure \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, B). By grouping stent lengths, a correlation was found between T and stent length in patients with LAD implantation (Pearson R=0.437, P\u0026lt;0.01), whereas the correlation between T and stent length for patients with LCX and RCA implantation had no statistical significance (LCX: Pearson R=0.206, P=0.283, RCA: Pearson R =0.246, P=0.160) (Figure \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, A); after grouping the stent lengths of patients with LAD stenting, a one-way ANOVA revealed statistically significant differences in T values between stent length groups (F=17.229, P\u0026lt;0.001), and a two-way comparison between the LAD, LCX and RCA groups revealed that the differences in T values in groups I, II and III had statistical significance. The difference between the LAD, LCX and RCA groups was statistically significant (LSD: P\u0026lt;0.01). The T value of the left ventricular diastolic function index increased with increasing stent length. The degree of deterioration of LVDF gradually increased (Figure \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, B)\u003c/p\u003e\n\u003cp\u003ePatients in group D were divided into groups, which were LAD single, two and three stent, according to the number of stents, with LAD two and three stents accounting for only 8.3% and 2.1% of the LAD implanted stents. A one-way ANOVA was applied to find that T values increased with the number of stents in each group, which means the differences in stent length and T-value were statistically significant in the different LAD groups (stent length F=147.408, P\u0026lt;0.001; T-value F=11.834, P\u0026lt;0.001) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), and there was a correlation between the increasement in T-value and stent length (Pearson R=0.546, P\u0026lt;0.001). The correlation is that the longer the stent length is, the greater the increasement in LV diastolic function after PCI is. The longer the stent length, the worse the LV diastolic function after PCI (Figure \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, C). After grouping the T values in the LAD, 2LAD and 3LAD groups according to the upper limit of normal T values, a ROC curve was plotted to determine the optimal cut-off value of 24.5 mm for stent length (sensitivity 0.602, specificity 1.000, area under the curve 0.844, CI: 0.747-0.942, p\u0026lt;0.001) (Figure \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLAD single stent vs LAD multi-stent immediate post-operative data\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLAD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2LAD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3LAD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=129 )\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=12 )\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e( n=3 )\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStent length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.9(6.4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.8(11.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.3(6.7)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183.1(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e186.3(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183.0(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.6(3.8)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.7(2.7)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.5(1.7)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9(0.2)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2(0.1)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2(0.1)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV+dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2477.0\u003c/p\u003e\n \u003cp\u003e(2446.4-2535.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2486.6\u003c/p\u003e\n \u003cp\u003e(2449.0-2554.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2463.7\u003c/p\u003e\n \u003cp\u003e(2437.1-2526.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLV-dp/dtmax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2295.6\u003c/p\u003e\n \u003cp\u003e(2243.9-2348.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2339.0\u003c/p\u003e\n \u003cp\u003e(2314.4-2381.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2285.9\u003c/p\u003e\n \u003cp\u003e(2275.3-2338.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCEDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4(0.2)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7(0.1)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7(0.1)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCESV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eValues are mean\u0026plusmn;standard deviation or median (interquartile spacing). K, stiffness index; LV+dp/dtmax, maximum rate of left ventricular pressure rise; LV-dp/dtmax, maximum rate of left ventricular pressure drop; CEDV, coronary artery end-diastolic volume; CESV, coronary artery end-systolic volume; C+dp/dtmax, maximum rate of coronary artery pressure rise; C-dp/dtmax, maximum rate of coronary artery pressure drop. Each subscript letter denotes a subset of categories whose row proportions do not differ significantly from each other at the .05 level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDiastolic heart failure is a common clinical syndrome. The prevalence is increasing because of an ageing population and increasing co-morbidity burden. More than half of patients with exertional dyspnea of unknown origin assessed invasively have diastolic heart failure, and more than 70% of heart failure patients over 65 years old have diastolic heart failure [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Left ventricular diastolic function plays an important role in the evaluation of clinical symptoms, treatment options and prognosis of patients with cardiovascular disease, and early and aggressive treatment of patients with diastolic dysfunction can prevent or delay the onset of heart failure [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this study, coronary atherosclerosis and the implantation of stents during PCI caused a decrease in the compliance of the coronary arteries that travel on the surface of the heart, and the small blood vessels that distribute between the myocardium, resulting in a constricting effect on the heart and thus affecting diastolic function.\u003c/p\u003e \u003cp\u003eThe data were collected and analyzed from 540 PCI patients and the data showed that, excluding other factors, the diastolic function index T increased with age, and the diastolic function of patients decreased (Pearson R=0.696, P\u0026lt;0.001). Further grouped patients undergoing PCI showed that diastolic function decreased significantly in the immediate post-PCI period in patients with LAD lesions, whereas there was no significant decrease in diastolic function in patients with LCX and RCA lesions. With the number of stents implanted increased, T values also increased. The total length of the stent implanted was positively correlated with the T value, which shows that the longer the length of the stent implanted is, the worse the patient's diastolic function in the immediate postoperative period is. But when coronary angiography was repeated 1 year after stent implantation, the T value of the patient's left ventricular diastolic function was found to have recovered.\u003c/p\u003e \u003cp\u003eThe degree of coronary artery disease has been shown to correlate with left ventricular diastolic function [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A foreign clinical study investigated the relationship between the degree of coronary stenosis and left ventricular diastole by using non-invasive coronary CT, with an increase in LVEDP of 0.8 mmHg for every 0.05-1.1 increase in coronary segmental stenosis score [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], suggesting a decrease in left ventricular compliance due to myocardial ischemia because of insufficient coronary blood supply. Coronary atherosclerosis is caused by the accumulation of LDL to form lipid plaques, and the narrowing and narrowing of the lumen is accompanied by a hardening and loss of elasticity of the vessel wall. In this study, the degree of coronary artery disease was found to be involved in diastolic insufficiency through myocardial ischemia. The results show that coronary artery disease and the changes in ischemia and hypoxia in the small vessels it affects can cause a decreasement in diastolic function, and that the more severe the coronary artery disease is, the worse the diastolic function is. And coronary atherosclerosis may reduce the compliance of the coronary arteries and thus have a restraining effect on the contraction and diastole of the heart. Atherosclerosis of the coronary arteries can reduce the elasticity of the vessels and have a constricting effect on the heart, theoretically resulting in a reduction in diastolic function. It was found by this study that the change in LV diastolic function was mainly affected by LAD and its small vessel lesions. And what is more, the more severe the LAD lesion is, the worse the diastolic function in the absence of external intervention is. One year after stent implantation, the patient's left ventricular function basically returned to normal after one year as the stent opened the vessel and as the coronary vessels adapted to the stent allowing vascular compliance to return, thus restoring the blood and oxygen supply to the ventricles.\u003c/p\u003e \u003cp\u003ePrevious studies have done some comparison on LVEF for patients undergoing PCI using echocardiography before, 1 day after and 3-6 months after the procedure. It was found that LVEF improved significantly at 1 day and 3-6 months after the procedure, whereas diastolic function improved at 1 day but did not change 3-6 months after the procedure [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Other studies have shown that LV diastolic function is altered after PCI [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These studies have used non-invasive tests and have small sample sizes. The present studies used the left ventricular isovolumic relaxation time constant T, which is less affected by other factors, to represent left ventricular diastolic function using an invasive catheter method and therefore, it could be more accurately to reflect the changes in left ventricular diastolic function for patients after surgery[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study had some limitations. First, the patients selected were limited to Fengxian District Central Hospital and not randomly selected patients across the country; second, the study was retrospective and not prospective. Therefore, the effect of stent length and stent implantation site on post-PCI needs to be further investigated.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, by comparing patients with different degrees of coronary artery stenosis, it was verified that coronary atherosclerosis can lead to a decrease in compliance of the coronary arteries travelling on the surface of the heart and the small vessels distributed between the myocardium, and it was also found that as the degree of coronary stenosis increased, LV diastolic function gradually decreased; and by further investigation, it was found that the degree of LAD vessel lesion and the LAD stent implantation It was also found that the degree of LAD vessel disease and the length of LAD stent implantation were closely related to the degree of reduction in LV diastolic function. The discovery could provide new clinical ideas for active intervention in postoperative patients with cardiovascular events such as diastolic insufficiency, and also provide some clinical evidence to help clinicians better judge the application of stents in patients who need to undergo PCI length.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eLVDF: \u003c/strong\u003eLeft ventricular diastolic function\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCHD: \u003c/strong\u003eCoronary heart disease\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLAD: \u003c/strong\u003eLeft anterior descending artery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLCX: \u003c/strong\u003eLeft circumflex artery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRCA: \u003c/strong\u003eRight coronary artery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVDD: \u003c/strong\u003eLeft ventricular diastolic dysfunction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePCI: \u003c/strong\u003ePercutaneous coronary intervention\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNYHA: \u003c/strong\u003eNew York Heart Association\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eK: \u003c/strong\u003eLeft ventricular stiffness index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDPV: \u003c/strong\u003eDiastolic-Pressure-Volume Curve\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCEDV: \u003c/strong\u003eEnd-diastolic coronary volume\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCESV: \u003c/strong\u003eEnd-systolic coronary volume\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC+dp/dtmax: \u003c/strong\u003eMaximum rate of increase in coronary pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC-dp/dtmax: \u003c/strong\u003eMaximum rate of decrease in coronary pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCAG: \u003c/strong\u003eCoronary angiography\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVEDV: \u003c/strong\u003eLeft ventricular end-diastolic volume\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVESV: \u003c/strong\u003eLeft ventricular end-systolic volume\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVEF: \u003c/strong\u003eLeft ventricular ejection fraction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLV+dp/dtmax: \u003c/strong\u003eMaximum rate of left ventricular pressure rise\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLV-dp/dtmax: \u003c/strong\u003eMaximum rate of left ventricular pressure fall\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePFR: \u003c/strong\u003eMaximum left ventricular filling rate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eT:\u003c/strong\u003e Time constant of relaxation \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll included patients gave their oral and written informed consent. The study was approved by the Ethics Committee (full name: the Shanghai Fengxian District Central Hospital Medical Ethics Committee)(reference number: 2014-KY-06) to Department of Cardiology, Fengxian Branch of Shanghai 6\u003csup\u003eth\u003c/sup\u003e People\u0026rsquo;s Hospital, Shanghai , China \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to human data and are available from the corresponding author upon reasonable request. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Shanghai Municipal Health Commission, China (No.202140493) and the Shanghai Science and Technology Committee of Shanghai, China (No.17411969400) \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJiangwei Ma conceived of and designed the experiments. Liang Lv and Yanan Xu performed the experiments. Liang Lv analyzed the data. Liang Lv and Shanshan Kan prepared the figures and wrote the manuscript. Qiong Zhang, Xiaomin Chen, Huajin Liu, Hongwei Wang and Changhua Wang revised the manuscript. All authors read and approved the final manuscript. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Dr. Kangjian Zhang for helpful discussions on topics related to this work. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Chinese Society of Interventional Cardiology and Chinese Society of Cardiology are different.\u003c/p\u003e\n\u003cp\u003eAnd all methods were carried out in accordance with relevant guidelines and regulations or according to Declaration of Helsinki.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMusunuru, K. and S. Kathiresan, Genetics of Common, Complex Coronary Artery Disease. 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International Journal of Cardiology, 2015. 187: p.\u0026nbsp;90\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-1287458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1287458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePrevious studies of left ventricular diastolic function (LVDF) have focused on the decrease in active and passive diastolic function due to ischemic factors but have not investigated if the decrease in compliance of the coronary arteries that bypass the surface of the heart and travel between the myocardium could cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods and Results:\u003c/strong\u003e From October 2016 to October 2019, the Department of Cardiology of Fengxian District Central Hospital treated 581 patients diagnosed with coronary heart disease (CHD). They were divided into groups according to the degree of coronary stenosis, the number of stents and the length of stents implanted. It was concluded that there was a statistical difference in Gensini scores between patients in groups B, C and D (P\u0026lt;0.001). And multiple linear regression analysis showed that T was correlated with Gensini score and C-dp/dtmax(R=0.711, P\u0026lt;0.001). Grouping according to the site of stent implantation and the number of stents implanted, it was found out that the changes in T values before and after left anterior descending artery (LAD) stent implantation were greater than left circumflex artery (LCX) and right coronary artery (RCA) (P\u0026lt;0.001). And multiple linear regression revealed a correlation between T values and stent length, ventricular stiffness, and C-dp/dtmax(P=0.001). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The decrease in compliance of the coronary arteries bypassing the surface of the heart and travelling between the myocardium would cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.\u003c/p\u003e","manuscriptTitle":"The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-02-07 19:00:24","doi":"10.21203/rs.3.rs-1287458/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-03-29T04:26:05+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"e85fc489-f054-4e4b-8d40-2e605811e47c","date":"2022-03-04T04:20:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-03-03T11:25:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d32b3e9f-7cfb-4b4f-9f32-f886a9801872","date":"2022-02-20T06:39:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-02-17T04:30:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-02-17T04:23:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-02-03T08:02:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-02-03T07:55:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2022-01-23T00:19:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed693e0b-2052-485e-84f2-1118105640b9","owner":[],"postedDate":"February 7th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-08-08T08:59:16+00:00","versionOfRecord":[],"versionCreatedAt":"2022-02-07 19:00:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1287458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1287458","identity":"rs-1287458","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}