Abstract
BackgroundDiabetes mellitus is a major risk factor for coronary artery disease (CAD) and may provoke structural and functional changes in coronary vasculature. The coronary volume to left ventricular mass (V/M) ratio is a new anatomical parameter capable of revealing a potential physiological imbalance between coronary vasculature and myocardial mass. The aim of this study was to examine the V/M derived from coronary computed tomography angiography (CCTA) in patients with diabetes. MethodsPatients with clinically suspected CAD enrolled in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry and known diabetic status were included. Coronary artery volume and left ventricular myocardial mass were analyzed from CCTA and the V/M ratio was calculated and compared between patients with and without diabetes. ResultsOf the 3053 patients (age 66 ± 10 years; 66% male) with known diabetic status, diabetes was present in 21.9%. Coronary volume was lower in patients with diabetes compared to those without diabetes (2850 ± 940 mm3 vs. 3040 ± 970 mm3, p < 0.0001), whereas the myocardial mass was comparable between the 2 groups (122 ± 33 g vs. 122 ± 32 g, p = 0.70). The V/M ratio was significantly lower in patients with diabetes (23.9 ± 6.8 mm3/g vs. 25.7 ± 7.5 mm3/g, p < 0.0001). Among subjects with obstructive CAD (n = 2191, 24.0% diabetics) and non-obstructive CAD (16.7% diabetics), the V/M ratio was significantly lower in patients with diabetes compared to those without (23.4 ± 6.7 mm3/g vs. 25.0 ± 7.3 mm3/g, p < 0.0001 and 25.6 ± 6.9 mm3/g vs. 27.3 ± 7.6 mm3/g, respectively, p = 0.006). ConclusionThe V/M ratio was significantly lower in patients with diabetes compared to non-diabetics, even after correcting for obstructive coronary stenosis. The clinical value of the reduced V/M ratio in diabetic patients needs further investigation.
Highlights
The aim of this study is to evaluate the association of the ventricular mass (V/M) ratio with the diabetic status using the data from a large multicenter registry comprising diabetic and non-diabetic subjects with clinically suspected coronary artery disease (CAD)
Comparison of the patients included in the analysis versus those excluded due to missing V/M ratios is shown in the Supplemental Table 1
Previous studies including data from the NXT (Analysis of Coronary Blood Flow Using CT Angiography: Steps) and PACIFIC (Prospective Comparison of coronary computed tomography angiography (CCTA), SPECT, PET, and Hybrid Imaging for Diagnosis of Ischemic Heart Disease using fractional flow reserve (FFR)) trials reported that patients with a low V/M ratio had more extensive atherosclerosis and reduced myocardial blood flow on positron emission tomography compared to patients with a high V/M ratio.[3]
Summary
The ratio of the total epicardial coronary artery lumen volume to left ventricular (LV) myocardial mass (V/M) is a newly available anatomical parameter capable of revealing a potential physiological imbalance between the supply (coronary artery epicardial volume) and demand (myocardial mass).[1,2] Previous studies observed that low V/M ratios derived from coronary computed tomography angiography (CCTA) were related with more advanced CAD, reduced myocardial blood flow and lesion-specific fractional flow reserve (FFR) 0.80 suggesting ischemia.[2,3]Diabetes mellitus is a major risk factor for CAD affecting millions of people worldwide.[4,5] diabetes has been associated with increased total coronary artery plaque burden, more advanced coronary atherosclerosis, and increased risk of adverse cardiovascular events.[6,7,8,9,10] In addition, diabetes has been associated with abnormalities in the coronary circulation including microvascular dysfunction and reduced vasodilation capacity.[11]The high rate of adverse events in diabetic patients with CAD has raised questions about the roles of anatomic and functional characteristics of diabetic coronary arteries. The coronary volume to left ventricular mass (V/M) ratio is a new anatomical parameter capable of revealing a potential physiological imbalance between coronary vasculature and myocardial mass. The aim of this study was to examine the V/M derived from coronary computed tomography angiography (CCTA) in patients with diabetes. Methods: Patients with clinically suspected CAD enrolled in the ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry and known diabetic status were included. Coronary artery volume and left ventricular myocardial mass were analyzed from CCTA and the V/M ratio was calculated and compared between patients with and without diabetes. Among subjects with obstructive CAD (n 1⁄4 2191, 24.0% diabetics)
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