Key result
Hypertension is not associated with altered coronary volume to left ventricular mass ratio.
Why the study?
It was hypothesized that hypertension decreases the coronary volume to left ventricular mass ratio through myocardial hypertrophy, potentially explaining abnormal myocardial perfusion reserve.
Does hypertension decrease the coronary vascular volume to left ventricular myocardial mass (V/M) ratio compared to normotension in non-diabetic patients with suspected coronary artery disease?
Cohort (n=2,378)
Yes
Does hypertension decrease the coronary vascular volume to left ventricular myocardial mass (V/M) ratio compared to normotension in non-diabetic patients with suspected coronary artery disease?
In non-diabetic patients with suspected CAD, hypertension is associated with proportional increases in both epicardial coronary volume and LV myocardial mass, resulting in a preserved V/M ratio and refuting the hypothesis that a reduced V/M ratio explains impaired perfusion reserve in hypertension.
Hypertension does not alter adjusted V/M ratio in suspected CAD; leaves open alternative mechanisms for impaired perfusion reserve.
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 mm 3 vs 2,965.6 ± 943.7 mm 3 , p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm 3 /g vs 25.3 ± 7.3 mm 3 /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) mm 3 , 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) mm 3 /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.
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Rosendael et al. (2023) conducted a cohort in Suspected coronary artery disease with known hypertension status (n=2,378). Hypertension vs. Normotensive patients (no hypertension) was evaluated on Coronary vascular volume to left ventricular myocardial mass (V/M) ratio assessed by CCTA (mm3/g) (MD 0.48, 95% CI -0.12 to 1.08, p=0.116). Hypertension was not associated with a significantly different adjusted coronary volume to left ventricular mass ratio compared to normotension (LS mean difference 0.48 mm3/g, p=0.116).
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