In severe CAD, a low coronary artery volume to myocardial mass ratio was linked to higher LV myocardium at risk and lower absolute plaque volume but higher relative plaque burden.
How does the coronary artery volume to myocardial mass (V/M) ratio correlate with plaque volume and composition in patients with severe coronary artery disease?
In patients with severe CAD, a low V/M ratio on CCTA is associated with higher myocardial mass at risk and higher relative plaque burden despite lower absolute plaque volume, suggesting advanced constrictive remodeling.
Abstract Background Artificial Intelligence-based Quantitative Coronary Plaque and Hemodynamic Analysis (AI-QCPHA) of computed tomography angiography (CCTA) enables non-invasive assessment of the coronary artery lumen volume to myocardial mass (V/M) ratio, percent left ventricular myocardial blood flow (LV%MYO) at risk, and quantitative plaque volume and composition analysis. We investigated the relationships between global and regional V/M ratios and plaque quantification in patients with severe coronary artery disease. Methods This is a sub-analysis of the first-in-human FASTTRACK CABG trial. AI-QCPHA analysis (HeartFlow, Mountainview, CA, USA) was used to assess V/M ratios, LV%MYO, and total (TPV), calcified (CP), non-calcified (NCP), and low-attenuation plaque (LAP) volumes. The global V/M ratio was calculated from the segmented coronary luminal volume (V) and left ventricular myocardium mass (M), while the regional V/M ratios were derived from the regional V and the regional M based on the LV%MYO (Figure 1). Results AI-QCPHA analysis was feasible in 106 of the 114 patients. Comparing with the high V/M group, patients with low V/M ratios had higher LV%MYO at risk (79.1% vs. 65.8%, p0.001) but lower TPV (986 mm³ vs. 1197 mm³, p=0.046), driven by lower NCP (657 mm³ vs. 925 mm³, p=0.005) though their percent atheroma volume (PAV) remained higher (47.2% vs. 40.4%, p=0.012) and their vessel volume was lower, suggesting constrictive remodelling. Due to its low partition in LV%MYO, the RCA had the highest V/M ratio, while the LAD exhibited the highest TPV, NCP, CP, LAP, and PAV. Except for the RCA, the global, LAD, and LCX V/M ratios were associated with TPV and NCP. PAV was an independent predictor for low global V/M ratio (Figure 2). Conclusion In patients with severe CAD, a low V/M ratio was associated with a higher LV%MYO at risk and lower absolute plaque volume but not with relative plaque burden, suggesting an advanced vessel remodelling process. Regional variations in the V/M ratio and its association with plaque composition were noticeable, suggesting distinct differences in vessel-specific CAD characteristics.
Tsai et al. (2025) studied this question. In severe CAD, a low coronary artery volume to myocardial mass ratio was linked to higher LV myocardium at risk and lower absolute plaque volume but higher relative plaque burden.
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