Coronary Volume to Left Ventricular Mass Ratio in Patients With Hypertension

The coronary vascular volume to left ventricular mass (V/M) ratio assessed by coronary computed tomography angiography (CCTA) is a promising new parameter to investigate the relation of coronary vasculature to the myocardium supplied. It is hypothesized that hypertension decreases the ratio between coronary volume and myocardial mass by way of myocardial hypertrophy, which could explain the detected abnormal myocardial perfusion reserve reported in patients with hypertension. Individuals enrolled in the multicenter ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry who underwent clinically indicated CCTA for analysis of suspected coronary artery disease with known hypertension status were included in current analysis. The V/M ratio was calculated from CCTA by segmenting the coronary artery luminal volume and left ventricular myocardial mass. In total, 2,378 subjects were included in this study, of whom 1,346 (56%) had hypertension. Left ventricular myocardial mass and coronary volume were higher in subjects with hypertension than normotensive patients (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039, and 3,105.0 ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm3/g vs 25.3 ± 7.3 mm3/g, p = 0.024). After correcting for potential confounding factors, the coronary volume and ventricular mass remained higher in patients with hypertension (least square) mean difference estimate: 196.3 (95% confidence intervals [CI] 119.9 to 272.7) mm3, p <0.001, and 5.60 (95% CI 3.42 to 7.78) g, p <0.001, respectively), but the V/M ratio was not significantly different (least square mean difference estimate: 0.48 (95% CI −0.12 to 1.08) mm3/g, p = 0.116). In conclusion, our findings do not support the hypothesis that the abnormal perfusion reserve would be caused by reduced V/M ratio in patients with hypertension. The coronary vascular volume to left ventricular mass (V/M) ratio assessed by coronary computed tomography angiography (CCTA) is a promising new parameter to investigate the relation of coronary vasculature to the myocardium supplied. It is hypothesized that hypertension decreases the ratio between coronary volume and myocardial mass by way of myocardial hypertrophy, which could explain the detected abnormal myocardial perfusion reserve reported in patients with hypertension. Individuals enrolled in the multicenter ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry who underwent clinically indicated CCTA for analysis of suspected coronary artery disease with known hypertension status were included in current analysis. The V/M ratio was calculated from CCTA by segmenting the coronary artery luminal volume and left ventricular myocardial mass. In total, 2,378 subjects were included in this study, of whom 1,346 (56%) had hypertension. Left ventricular myocardial mass and coronary volume were higher in subjects with hypertension than normotensive patients (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039, and 3,105.0 ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm3/g vs 25.3 ± 7.3 mm3/g, p = 0.024). After correcting for potential confounding factors, the coronary volume and ventricular mass remained higher in patients with hypertension (least square) mean difference estimate: 196.3 (95% confidence intervals [CI] 119.9 to 272.7) mm3, p <0.001, and 5.60 (95% CI 3.42 to 7.78) g, p <0.001, respectively), but the V/M ratio was not significantly different (least square mean difference estimate: 0.48 (95% CI −0.12 to 1.08) mm3/g, p = 0.116). In conclusion, our findings do not support the hypothesis that the abnormal perfusion reserve would be caused by reduced V/M ratio in patients with hypertension. Hypertension causes changes in the coronary circulation, characterized by a reduction of the coronary vascular reserve.1Treasure CB Klein JL Vita JA Manoukian SV Renwick GH Selwyn AP Ganz P Alexander RW. Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels.Circulation. 1993; 87: 86-93Google Scholar, 2Leschke M Schoebel FC Vogt M Heintzen M Kelm M Motz W Strauer BE. Reduced peripheral and coronary vasomotion in systemic hypertension.Eur Heart J. 1992; 13: 96-99Google Scholar, 3Antony I Nitenberg A Foult JM Aptecar E. Coronary vasodilator reserve in untreated and treated hypertensive patients with and without left ventricular hypertrophy.J Am Coll Cardiol. 1993; 22: 514-520Google Scholar, 4Strauer BE Vogt M Motz W. ACE-inhibitors and coronary microcirculation.Basic Res Cardiol. 1993; 88: 97-106Google Scholar, 5Vogt M Motz W Strauer BE. 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Myocardial oxygen consumption is unchanged but efficiency is reduced in patients with essential hypertension and left ventricular hypertrophy.Circulation. 1999; 100: 2425-2430Google Scholar, 15Galderisi M de Simone G Cicala S Parisi M D'Errico A Innelli P de Divitiis M Mondillo S de Divitiis O Coronary flow reserve in hypertensive patients with hypercholesterolemia and without coronary heart disease.Am J Hypertens. 2007; 20: 177-183Google Scholar, 16Frohlich ED. Hypertension left ventricular hypertrophy, and coronary flow reserve.Adv Exp Med Biol. 1997; 432: 253-262Google Scholar The ratio of the total epicardial coronary artery luminal volume to LV myocardial mass (V/M ratio) is considered a parameter capable of revealing a potential physiologic imbalance between coronary blood supply and myocardial demand.17Ihdayhid AR Fairbairn TA Gulsin GS Tzimas G Danehy E Updegrove A Jensen JM Taylor CA Bax JJ Sellers SL Leipsic JA Nørgaard BL. Cardiac computed tomography-derived coronary artery volume to myocardial mass.J Cardiovasc Comput Tomogr. 2022; 16: 198-206Google Scholar Low V/M ratios were associated with more advanced coronary artery disease (CAD), reduced myocardial blood flow, and lesion-specific fractional flow reserve <0.80.18van Diemen PA Schumacher SP Bom MJ Driessen RS Everaars H Stuijfzand WJ Raijmakers PG van de Ven PM Min JK Leipsic JA Knuuti J Boellaard PR Taylor CA van Rossum AC Danad I Knaapen P. The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve.J Cardiovasc Comput Tomogr. 2019; 13: 179-187Google Scholar,19Taylor CA Gaur S Leipsic J Achenbach S Berman DS Jensen JM Dey D Bøtker HE Kim HJ Khem S Wilk A Zarins CK Bezerra H Lesser J Ko B Narula J Ahmadi A Øvrehus KA St Goar F De Bruyne B Nørgaard BL. Effect of the ratio of coronary arterial lumen volume to left ventricle myocardial mass derived from coronary CT angiography on fractional flow reserve.J Cardiovasc Comput Tomogr. 2017; 11: 429-436Google Scholar Based on previous studies observing reduced coronary flow reserve in patients with hypertension, we hypothesized that patients with hypertension may have a lower V/M ratio than normotensive patients. ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) is a multinational (38 sites in Europe, North America, and Japan) registry with prospective follow-up data of patients being investigated for clinically suspected CAD designed to understand the effect of coronary computed tomography angiography (CCTA)-derived fractional flow reserve on clinical practice. The study design has been described earlier in detail.20Chinnaiyan KM Akasaka T Amano T Bax JJ Blanke P De Bruyne B Kawasaki T Leipsic J Matsuo H Morino Y Nieman K Norgaard BL Patel MR Pontone G Rabbat M Rogers C Sand NP Raff G. Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFRCT in Coronary Care (ADVANCE) registry.J Cardiovasc Comput Tomogr. 2017; 11: 62-67Google Scholar In summary, subjects were enrolled from July 15, 2015 to October 20, 2017. Patients aged >18 years with documented stenosis of at least 30% on CCTA were included. Patients with an insufficient CCTA image quality, an inability to comply with follow-up requirements, and a life expectancy <1 year were excluded. For the present analysis, patients with known hypertension status and available coronary artery luminal volume and LV myocardial mass analysis were included (Figure 1). Patients with diabetes were excluded to reduce the confounding effects of diabetes on V/M.21Kuneman JH El Mahdiui M van Rosendael AR van den Hoogen IJ Patel MR Nørgaard BL Fairbairn TA Nieman K Akasaka T Berman DS Hurwitz Koweek LM Pontone G Kawasaki T Rønnow Sand NP Jensen JM Amano T Poon M Øvrehus KA Sonck J Rabbat MG De Bruyne B Rogers C Matsuo H Bax JJ Leipsic JA Knuuti J Coronary volume to left ventricular mass ratio in patients with diabetes mellitus.J Cardiovasc Comput Tomogr. 2022; 16: 319-326Google Scholar The study was conducted in accordance with the Declaration of Helsinki. All individuals provided written informed consent after local institutional review board review and approval. All CCTA scans were performed with ≥64-row multidetector computed tomography scanners. If the prescan heart rate was >60 beats/min, patients received metoprolol before the CCTA scan, unless contraindicated. Sublingual nitrates were administered to all patients before scanning. Coronary arteries with a diameter of ≥2 mm were evaluated for stenosis severity in accordance with current to the clinical J S Achenbach S R Nieman K Pontone G Raff for the and of coronary CT a of the of Cardiovasc Comput Tomogr. Scholar HeartFlow a computed the V/M which has been described KM Akasaka T Amano T Bax JJ Blanke P De Bruyne B Kawasaki T Leipsic J Matsuo H Morino Y Nieman K Norgaard BL Patel MR Pontone G Rabbat M Rogers C Sand NP Raff G. Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFRCT in Coronary Care (ADVANCE) registry.J Cardiovasc Comput Tomogr. 2017; 11: 62-67Google R Leipsic JA J M Nørgaard BL A Bax JJ Blanke P T Sellers Coronary lumen volume to myocardial mass ratio in microvascular Cardiovasc Comput Tomogr. 2017; 11: Scholar, CA TA Min to computed tomography for of fractional flow reserve: Am Coll Cardiol. Scholar, S Achenbach S Leipsic J Bezerra Jensen JM Bøtker HE Nørgaard BL. and design of the analysis of coronary blood flow CT Cardiovasc Comput Tomogr. Scholar, H Leipsic J Patel MR Nieman K De Bruyne B Rogers C Pontone G Nørgaard BL Bax JJ Raff G KM Rabbat M Rønnow Sand NP Blanke P Fairbairn TA Matsuo H Amano T Kawasaki T Morino Y Akasaka T and of lesion-specific by from the ADVANCE registry.J Cardiovasc Comput Tomogr. Scholar In a epicardial of the coronary was derived from the CCTA The total coronary arterial luminal volume is calculated by the of all the coronary The volume of the myocardium from CCTA was by an value for myocardial in the left ventricle myocardial TA R Matsuo H Norgaard BL Rønnow Sand NP Nieman K Bax JJ Pontone G Raff G KM Rabbat M Amano T Kawasaki T Akasaka T H S Rogers C Berman D Patel MR Leipsic J in coronary computed tomography fractional flow reserve: from Cardiovasc Imaging. 13: Scholar Subsequently, the ratio between the total coronary artery luminal volume and the LV myocardial mass was of the study the analysis of the V/M ratio could not be performed in all patients. The of hypertension were on the in the and blood of mm blood of mm patients with and without CAD the coronary artery luminal volume and LV myocardial mass were CAD was diameter were performed with North with a normal are mean ± and were the analysis of are with to and were the U are and and were the for potential confounding effects on the coronary artery luminal LV myocardial and V/M analysis of were mass of with and the of stenosis were in this analysis. The in total coronary artery luminal LV myocardial and V/M ratio between hypertensive and normotensive patients are least square mean difference with confidence intervals A p was considered A total of individuals were enrolled in the ADVANCE 2,378 patients without diabetes with known hypertension status and V/M ratio were included in present analysis. Hypertension was present in 1,346 patients and clinical of the enrolled patients are in Patients with hypertension were ± vs ± p and had a higher ± vs ± p In patients with hypertension had more a of and were more to be = of the and to hypertension hypertension CAD status angina are = mass CAD = coronary artery = in a new are = mass CAD = coronary artery = Patients with hypertension had more CAD by CCTA = In the analysis, the volume of epicardial coronary arteries was higher in patients with hypertension ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p = The LV myocardial mass was higher in patients with hypertension (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = in a higher V/M ratio in patients with hypertension than patients without hypertension (26.0 ± 7.6 mm3/g vs 25.3 ± 7.3 mm3/g, p = 0.024). correcting for the in and CCTA the coronary volume and myocardial mass remained significantly higher in patients with hypertension mean difference estimate: 196.3 CI 119.9 to mm3, p mean difference estimate: 5.60 CI 3.42 to g, p <0.001, the V/M ratio difference between hypertensive and normotensive patients mean difference 0.48 CI −0.12 to mm3/g, p = computed tomography angiography of patients to hypertension hypertension stenosis stenosis stenosis stenosis stenosis of CAD stenosis stenosis stenosis stenosis stenosis stenosis volume myocardial mass coronary artery volume Left ventricle myocardial mass Coronary volume of with CAD are = coronary artery CCTA = coronary computed tomography DS = diameter = left = left = coronary in a new mass and coronary volume mass ratio for potential confounding mean difference (95% volume Hypertension of with CAD stenosis mass Hypertension of with CAD stenosis mass ratio Hypertension of with CAD stenosis = mass CAD = coronary artery CI = confidence = least in a new of with CAD are CAD = coronary artery CCTA = coronary computed tomography DS = diameter = left = left = coronary = mass CAD = coronary artery CI = confidence = least CAD has known effects on coronary the with and without CAD were CAD was present in subjects of whom had hypertension. In individuals with patients with hypertension were more = were had a higher = and had more a of Coronary volume not significantly between hypertensive and normotensive patients with CAD ± mm3 vs ± mm3, p = the LV mass was not significantly different between the ± g vs ± p = the V/M ratio was between the ± 7.3 mm3/g vs ± mm3/g, p = we for potential confounding the epicardial coronary artery volume and myocardial mass were significantly higher in patients with hypertension than normotensive patients mean difference estimate: CI to mm3, p = and mean difference estimate: CI to g, p the V/M ratio was not significantly different between the mean difference estimate: CI to mm3/g, p = and coronary computed tomography and coronary computed tomography angiography of patients with and without CAD to hypertension CAD CAD hypertension hypertension CAD of CAD stenosis stenosis stenosis stenosis stenosis stenosis volume myocardial coronary artery volume ventricle myocardial mass volume mass are = mass CAD = coronary artery DS = diameter = left = left = coronary in a new computed tomography angiography for potential confounding in patients with mean difference (95% volume Hypertension of with CAD stenosis mass Hypertension of with CAD stenosis mass ratio Hypertension of with CAD stenosis = mass CAD = coronary artery CI = confidence = least in a new are = mass CAD = coronary artery DS = diameter = left = left = coronary = mass CAD = coronary artery CI = confidence = least Hypertension was present in of patients without Patients with hypertension were more = had a higher = and had more a of Coronary volume was higher in patients with hypertension than normotensive patients without CAD ± mm3 vs ± p LV mass not significantly between the ± g vs ± g, p = the V/M ratio was significantly higher ± mm3/g vs ± mm3/g, p = in patients with hypertension than normotensive patients. Coronary artery volume remained significantly higher in patients with hypertension after for potential confounding mean difference estimate: (95% CI to mm3, p The myocardial mass after for confounding was significantly higher in patients with hypertension mean difference estimate: CI to g, p The V/M ratio remained higher in the patients with hypertension mean difference estimate: CI to mm3/g, p = computed tomography angiography for potential confounding in patients without mean difference (95% volume Hypertension stenosis mass Hypertension stenosis mass ratio Hypertension stenosis = mass CAD = coronary artery CI = confidence = least in a new = mass CAD = coronary artery CI = confidence = least study assessed the of hypertension on the V/M The hypothesis was that the known reduced myocardial perfusion reserve in patients with hypertension may be by an V/M because of myocardial hypertrophy not by increase in vascular The that the V/M ratio was not in patients with hypertension, that the myocardial mass was by vascular to V/M The V/M ratio has been to be reduced in patients with Diemen PA Schumacher SP Bom MJ Driessen RS Everaars H Stuijfzand WJ Raijmakers PG van de Ven PM Min JK Leipsic JA Knuuti J Boellaard PR Taylor CA van Rossum AC Danad I Knaapen P. The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve.J Cardiovasc Comput Tomogr. 2019; 13: 179-187Google Scholar is because CAD the coronary lumen and the that V/M ratio is reduced in patients with CAD was a confounding JH El Mahdiui M van Rosendael AR van den Hoogen IJ Patel MR Nørgaard BL Fairbairn TA Nieman K Akasaka T Berman DS Hurwitz Koweek LM Pontone G Kawasaki T Rønnow Sand NP Jensen JM Amano T Poon M Øvrehus KA Sonck J Rabbat MG De Bruyne B Rogers C Matsuo H Bax JJ Leipsic JA Knuuti J Coronary volume to left ventricular mass ratio in patients with diabetes mellitus.J Cardiovasc Comput Tomogr. 2022; 16: 319-326Google Scholar In this study, we excluded patients with diabetes and the patients with and without CAD was that in patients without the V/M ratio was higher in hypertensive myocardial mass. In patients with V/M ratio was not significantly different between patients with and without hypertension, because of the confounding effect of CAD on the V/M The of the V/M ratio was described by coronary flow coronary Cardiovasc Imaging. Scholar and the of assessing the V/M ratio is on a to the and of the of JH A for the of in 1997; Scholar of myocardial mass to flow and of coronary Scholar investigated the of myocardial flow and mass in a heart and reported a relation between coronary artery luminal volume and myocardial mass. studies the V/M ratio have that individuals with a V/M ratio had reduced myocardial blood flow on tomography with patients with a V/M Diemen PA Schumacher SP Bom MJ Driessen RS Everaars H Stuijfzand WJ Raijmakers PG van de Ven PM Min JK Leipsic JA Knuuti J Boellaard PR Taylor CA van Rossum AC Danad I Knaapen P. The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve.J Cardiovasc Comput Tomogr. 2019; 13: 179-187Google Scholar Taylor CA Gaur S Leipsic J Achenbach S Berman DS Jensen JM Dey D Bøtker HE Kim HJ Khem S Wilk A Zarins CK Bezerra H Lesser J Ko B Narula J Ahmadi A Øvrehus KA St Goar F De Bruyne B Nørgaard BL. Effect of the ratio of coronary arterial lumen volume to left ventricle myocardial mass derived from coronary CT angiography on fractional flow reserve.J Cardiovasc Comput Tomogr. 2017; 11: 429-436Google Scholar that the V/M ratio was associated with a fractional flow reserve the hypothesized that the abnormal myocardial perfusion in patients with hypertension was caused by a reduced V/M LV hypertrophy is associated with hypertension, the myocardial and is considered a mechanism to abnormal myocardial this study a increase in coronary artery to a V/M ratio in patients with hypertension. The coronary luminal volume in patients with hypertension we in this study is in with previous luminal of P C P B between local mean blood and 1999; 100: AP C P JM of local artery on Med Biol. 1997; Scholar and coronary arteries large to and are and large of blood from the left ventricle to A A H and between artery and coronary artery Scholar In disease and potential confounding effect to be the V/M ratio because the of and reduced coronary volume has been the is patients with and without patients with CAD to have different V/M ratio between patients with hypertension and normotensive patients. we in patients with hypertension without CAD an higher V/M ratio than normotensive patients. The increase in coronary luminal volume is than the increase of the ventricular mass. effect is in patients with CAD by the of more Coronary artery diameter is associated with the severity of coronary in patients coronary 2017; Scholar that the diameter of the coronary is associated with the severity of In because of with a reduction of vasodilator to a reduced coronary volume in patients J Ganz P. of in Scholar The design of the study has and The registry may have been to in local In the severity and of hypertension in the patients was and in our the increase of LV mass was being has been associated with the reduction of LV hypertrophy and have a effect on the between myocardial mass and O D C G A C M I A effects of and on myocardial blood flow in systemic 1997; Scholar were to increase and reduce oxygen consumption in coronary A to myocardial oxygen 1997; A J C P A review of the of and in the of on 2019; Scholar The of data could be a of the present study this study not for the of that myocardial blood flow disease and the of the total be considered a In conclusion, in to our the V/M ratio was not in patients with hypertension with patients without hypertension, and the abnormal coronary flow reserve in patients with hypertension is not caused by a reduced arterial volume to myocardial mass. studies are different to investigate the relation of flow reserve and V/M The of the has received from and Patel has received from and the and and has on the board for and Nørgaard has received an institutional from HeartFlow Fairbairn has on the for Nieman support from the and institutional support from from and in Berman has received support from Hurwitz Koweek has received support and from HeartFlow and Pontone has received institutional a from and Rabbat has a for Rogers is of and in Leipsic has received from and and has a for and in and HeartFlow has received from was without on by the Heart the the Heart and the Bax received from received from and received from and and from and Knuuti received from and and from and of the The have of to

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