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• W4377011660 abstract "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. Coronary haemodynamics in hypertensive heart disease.Eur Heart J. 1992; 13: 44-49Google Scholar, 6Brush Jr, JE Faxon DP Salmon S Jacobs AK Ryan TJ. Abnormal endothelium-dependent coronary vasomotion in hypertensive patients.J Am Coll Cardiol. 1992; 19: 809-815Google Scholar, 7Egashira K Suzuki S Hirooka Y Kai H Sugimachi M Imaizumi T Takeshita A. Impaired endothelium-dependent vasodilation of large epicardial and resistance coronary arteries in patients with essential hypertension. Different responses to acetylcholine and substance P.Hypertension. 1995; 25: 201-206Google Scholar, 8Motz W Strauer BE. Improvement of coronary flow reserve after long-term therapy with enalapril.Hypertension. 1996; 27: 1031-1038Google Scholar, 9Brush Jr, JE Cannon 3rd, RO Schenke WH Bonow RO Leon MB Maron BJ Epstein SE Angina due to coronary microvascular disease in hypertensive patients without left ventricular hypertrophy.N Engl J Med. 1988; 319: 1302-1307Google Scholar, 10Gaudieri V Acampa W Rozza F Nappi C Zampella E Assante R Mannarino T Mainolfi C Petretta M Verberne HJ Arumugam P Cuocolo A. Coronary vascular function in patients with resistant hypertension and normal myocardial perfusion: a propensity score analysis.Eur Heart J Cardiovasc Imaging. 2019; 20: 949-958Google Scholar Left ventricular (LV) hypertrophy, usually a complication of hypertension because of sustained elevated afterload, is associated with a reduction in maximal coronary vasodilator reserve11Strauer BE. Ventricular function and coronary hemodynamics in hypertensive heart disease.Am J Cardiol. 1979; 44: 999-1006Google Scholar, 12Opherk D Mall G Zebe H Schwarz F Weihe E Manthey J Kübler W. Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries.Circulation. 1984; 69: 1-7Google Scholar, 13Pichard AD Gorlin R Smith H Ambrose J Meller J. Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type. Evidence for an impaired coronary vascular reserve.Am J Cardiol. 1981; 47: 547-554Google Scholar and an increase in myocardial oxygen demand.14Laine H Katoh C Luotolahti M Yki-Järvinen H Kantola I Jula A Takala TO Ruotsalainen U Iida H Haaparanta M Nuutila P Knuuti J. 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 guidelines according to the clinical site procedures.22Leipsic J Abbara S Achenbach S Cury R Earls JP Mancini GJ Nieman K Pontone G Raff GL. SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.J Cardiovasc Comput Tomogr. 2014; 8: 342-358Google Scholar HeartFlow Inc. (Redwood City, California), a central core laboratory, computed the V/M analyses, which has been described previously.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,23Grover R Leipsic JA Mooney J Kueh SH Ohana M Nørgaard BL Eftekhari A Bax JJ Murphy DT Hague CJ Seidman MA Blanke P Sedlak T Sellers SL. Coronary lumen volume to myocardial mass ratio in primary microvascular angina.J Cardiovasc Comput Tomogr. 2017; 11: 423-428Google Scholar, 24Taylor CA Fonte TA Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis.J Am Coll Cardiol. 2013; 61: 2233-2241Google Scholar, 25Gaur S Achenbach S Leipsic J Mauri L Bezerra HG Jensen JM Bøtker HE Lassen JF Nørgaard BL. Rationale and design of the HeartFlowNXT (HeartFlow analysis of coronary blood flow using CT angiography: NeXt sTeps) study.J Cardiovasc Comput Tomogr. 2013; 7: 279-288Google Scholar, 26Kitabata H Leipsic J Patel MR Nieman K De Bruyne B Rogers C Pontone G Nørgaard BL Bax JJ Raff G Chinnaiyan KM Rabbat M Rønnow Sand NP Blanke P Fairbairn TA Matsuo H Amano T Kawasaki T Morino Y Akasaka T Incidence and predictors of lesion-specific ischemia by FFRCT: learnings from the international ADVANCE registry.J Cardiovasc Comput Tomogr. 2018; 12: 95-100Google Scholar In short, a patient-specific anatomic epicardial model of the coronary tree was derived from the CCTA images provided. The total coronary arterial luminal volume is calculated by the summation of all the segmented coronary arteries. The volume of the myocardium extracted from CCTA was multiplied by 1.05 g/ml, an average value for myocardial tissue density, resulting in the left ventricle myocardial mass.27Fairbairn TA Dobson R Hurwitz-Koweek L Matsuo H Norgaard BL Rønnow Sand NP Nieman K Bax JJ Pontone G Raff G Chinnaiyan KM Rabbat M Amano T Kawasaki T Akasaka T Kitabata H Binukrishnan S Rogers C Berman D Patel MR Douglas PS Leipsic J Sex differences in coronary computed tomography angiography-derived fractional flow reserve: lessons from ADVANCE.JACC Cardiovasc Imaging. 2020; 13: 2576-2587Google Scholar Subsequently, the ratio between the total coronary artery luminal volume and the LV myocardial mass was calculated. Because of software development during the study time period, the analysis of the V/M ratio could not be performed in all patients. The diagnoses of hypertension were based on the medical history in the electronic case report forms and defined as systolic blood pressure values of ≥140 mm Hg and/or diastolic blood pressure values of ≥90 mm Hg requiring treatment. Among patients with anatomically obstructive and without obstructive CAD the coronary artery luminal volume and LV myocardial mass were separately analyzed. Obstructive CAD was defined as ≥50% diameter stenosis. Statistical analyses were performed with SAS version 9.4 (SAS institute, Cary, North Carolina). Continuous variables with a normal distribution are presented as mean ± SD and were compared using the Student's t test or one-way analysis of variance, as appropriate. Non-normally distributed continuous variables are presented as median with (twenty-fifth to seventy-fifth interquartile range) and were compared using the Mann-Whitney U test. Categorical variables are presented as absolute numbers and percentages and were compared using the chi-square test. To correct for potential confounding effects on the coronary artery luminal volume, LV myocardial mass, and V/M ratio, analysis of covariance models were used. Age, body mass index (BMI), hyperlipidemia, gender, number of vessels with obstructive CAD, and the degree of maximum stenosis were used as covariates in this analysis. The differences in total coronary artery luminal volume, LV myocardial mass, and V/M ratio between hypertensive and normotensive patients are presented as least square (LS) mean difference estimate with corresponding 95% confidence intervals (CIs). A 2-sided p <0.05 was considered statistically significant. A total of 5,083 individuals were enrolled in the ADVANCE registry. Of these, 2,378 patients without diabetes with known hypertension status and measured V/M ratio were included in present analysis. Hypertension was present in 1,346 patients (60%). Baseline patient demographic and clinical characteristics of the enrolled patients are listed in Table 1. Patients with hypertension were older (67.8 ± 9.6 vs 63.9 ± 11.0 years, p <0.001) and had a higher BMI (26.4 ± 4.9 vs 25.6 ± 4.4 kg/m2, p <0.001). In addition, patients with hypertension had more frequently a history of hyperlipidemia (p <0.001) and were more likely to be female (p = 0.002).Table 1Baseline characteristics of the overall population and according to hypertension statusTotal (n=2,378)Hypertension (n=1,346)No hypertension (n=1,032)p ValueAge, (y) N2,2721288984<0.001 Mean±SD66.1±10.467.8±9.663.9±11.0 Min, max15.0, 93.034.0, 93.015.0, 92.0Male sex1,564 (65.8%)849 (63.1%)715 (69.3%)0.002BMI, (kg/m2) N2,34713321,015<0.001 Mean±SD26.1±4.726.4±4.925.6±4.4 Min, max14.9, 63.715.8, 63.714.9, 55.5Diamond Forrester CAD likelihood N2,25112819700.544 Mean±SD50.9±20.051.2±19.950.6±20.1 Min, max5.3, 92.58.0, 92.55.3, 92.5Hyperlipidemia Yes1,368 (57.5%)888 (66.0%)480 (46.5%)<0.001 No995 (41.8%)448 (33.3%)547 (53.0%) Unknown15 (0.6%)10 (0.7%)5 (0.5%)Tobacco use Current smoker364 (15.3%)191 (14.2%)173 (16.8%)0.072 Ex-smoker815 (34.3%)484 (36.0%)331 (32.1%) Never smoked1,020 (42.9%)571 (42.4%)449 (43.5%) Unknown179 (7.5%)100 (7.4%)79 (7.7%)Angina status Typical465 (19.6%)264 (19.6%)201 (19.5%)0.028 Atypical868 (36.5%)467 (34.7%)401 (38.9%) Dyspnea274 (11.5%)148 (11.0%)126 (12.2%) Non-cardiac pain150 (6.3%)85 (6.3%)65 (6.3%) None604 (25.4%)375 (27.9%)229 (22.2%) Unknown17 (0.7%)7 (0.5%)10 (1.0%)CCS angina class Grade I109/ 465 (23.4%)55/ 264 (20.8%)54/ 201 (26.9%)0.210 Grade II264/ 465 (56.8%)152/ 264 (57.6%)112/ 201 (55.7%) Grade III42/ 465 (9.0%)27/ 264 (10.2%)15/ 201 (7.5%) Grade IV6/ 465 (1.3%)5/ 264 (1.9%)1/ 201 (0.5%) Unknown44/ 465 (9.5%)25/ 264 (9.5%)19/ 201 (9.5%)Data are presented as mean±standard deviation or number (percentage), as appropriate.BMI = body mass index; CAD = coronary artery disease; CCS = Canadian Cardiovascular Society. Open table in a new tab Data are presented as mean±standard deviation or number (percentage), as appropriate. BMI = body mass index; CAD = coronary artery disease; CCS = Canadian Cardiovascular Society. Patients with hypertension had more frequently obstructive CAD by anatomic CCTA evaluation (p = 0.017; Table 2). In the quantitative analysis, the volume of epicardial coronary arteries was higher in patients with hypertension (3,105.0 ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p = 0.001). The LV myocardial mass was higher in patients with hypertension as well (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039). This resulted 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). When correcting for the differences in baseline and CCTA characteristics, the coronary volume and myocardial mass remained significantly higher in patients with hypertension (LS mean difference estimate: 196.3 [95% CI 119.9 to 272.7] mm3, p <0.001; LS mean difference estimate: 5.60 [95% CI 3.42 to 7.78] g, p <0.001, respectively; Figure 2, Table 3). Whereas the V/M ratio showed no significant difference between hypertensive and normotensive patients (LS mean difference estimate 0.48 [95% CI −0.12 to 1.08] mm3/g, p = 0.116).Table 2Coronary computed tomography angiography parameters of patients according to hypertension statusTotal (n=2,378)Hypertension (n=1,346)No hypertension (n=1,032)p ValueCCTA anatomical finding Without obstructive stenosis <50%711 (29.9%)376 (27.9%)335 (32.5%)0.017 Obstructive stenosis ≥50%1,663 (69.9%)968 (71.9%)695 (67.3%) Unknown4 (0.2%)2 (0.1%)2 (0.2%) Non-severe stenosis ≤70%1,676 (70.5%)943 (70.1%)733 (71.0%)0.596 Severe stenosis >70%698 (29.4%)401 (29.8%)297 (28.8%) Unknown4 (0.2%)2 (0.1%)2 (0.2%)Degree stenosis Normal (0%)15 (0.6%)6 (0.4%)9 (0.9%)0.040 Minimal (0%–30%)136 (5.7%)62 (4.6%)74 (7.2%) Mild (30%–50%)560 (23.5%)308 (22.9%)252 (24.4%) Moderate (50%–70%)965 (40.6%)567 (42.1%)398 (38.6%) Severe (70%–90%)493 (20.7%)288 (21.4%)205 (19.9%) Sub-total/occluded (≥90%/occluded)205 (8.6%)113 (8.4%)92 (8.9%) Unknown4 (0.2%)2 (0.1%)2 (0.2%) 0711 (29.9%)376 (27.9%)335 (32.5%)0.004 11,062 (44.7%)592 (44.0%)470 (45.5%) 2420 (17.7%)259 (19.2%)161 (15.6%) 3181 (7.6%)117 (8.7%)64 (6.2%) 4000 Unknown4 (0.2%)2 (0.1%)2 (0.2%)Rate of obstructive CAD per vessel LAD stenosis <50%1,069 (45.0%)584 (43.4%)485 (47.0%)0.080 LAD stenosis ≥50%1,309 (55.0%)762 (56.6%)547 (53.0%) LCX stenosis <50%1,860 (78.2%)1,030 (76.5%)830 (80.4%)0.022 LCX stenosis ≥50%518 (21.8%)316 (23.5%)202 (19.6%) RCA stenosis <50%1,760 (74.0%)963 (71.5%)797 (77.2%)0.002 RCA stenosis ≥50%618 (26.0%)383 (28.5%)235 (22.8%)Coronary volume - myocardial mass Epicardial coronary artery volume (mm3) N2,37813461,0320.001 Mean±SD3,044.5±973.63,105.0±992.02,965.6±943.7 Min, max704.6, 7,891.2732.1, 7,891.2704.6, 7,198.4 Left ventricle myocardial mass (g) N2,37813461,0320.039 Mean±SD121.6±31.8122.7±32.8120.0±30.5 Min, max54.9, 324.154.9, 324.156.9, 308.9 Coronary volume /mass (mm3/g) N2,37813461,0320.024 Mean±SD25.7±7.526.0±7.625.3±7.3 Min, max6.8, 62.56.8, 61.97.2, 62.5Number of vessels with anatomically obstructive CAD (>50% DS). Data are presented as mean±standard deviation or number (percentage), as appropriate.CAD = coronary artery disease; CCTA = coronary computed tomography angiography; DS = diameter stenosis; LAD = left anterior descending artery; LCX = left circumflex artery; RCA = right coronary artery. Open table in a new tab Table 3Coronary volume, cardiac mass and coronary volume : mass ratio corrected for potential confounding variablesModel effectLS mean difference (95% CI)p ValueTotal segmented volume Hypertension (yes/no)196.3 (119.9, 272.7)<0.001 Age0.735 BMI<0.001 Hyperlipidemia (yes/no)0.002 Sex (male/female)<0.001 Number of vessels with obstructive CAD (0,1,2,3)<0.001 Maximum stenosis % (0, >0−<30, ≥30−<50, ≥50−≤70, >70−≤90, >90)<0.001Myocardial mass Hypertension (yes/no)5.60 (3.42, 7.78)<0.001 Age<0.001 BMI<0.001 Hyperlipidemia (yes/no)<0.001 Sex (male/female)<0.001 Number of vessels with obstructive CAD (0,1,2,3)0.047 Maximum stenosis % (0, >0−<30, ≥30−<50, ≥50−≤70, >70−≤90, >90)<0.001Volume : mass ratio Hypertension (yes/no)0.48 (−0.12, 1.08)0.116 Age<0.001 BMI<0.001 Hyperlipidemia (yes/no)0.629 Sex (male/female)0.007 Number of vessels with obstructive CAD (0,1,2,3)<0.001 Maximum stenosis % (0, >0−<30, ≥30−<50, ≥50−≤70, >70−≤90, >90)<0.001BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; LS = least squares. Open table in a new tab Number of vessels with anatomically obstructive CAD (>50% DS). Data are presented as mean±standard deviation or number (percentage), as appropriate. CAD = coronary artery disease; CCTA = coronary computed tomography angiography; DS = diameter stenosis; LAD = left anterior descending artery; LCX = left circumflex artery; RCA = right coronary artery. BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; LS = least squares. Because CAD has known effects on coronary volume, the groups with and without obstructive CAD were analyzed separately (Table 4). Obstructive CAD was present in 1,663 subjects (69.9%), of whom 968 (58.2%) had hypertension. In individuals with obstructive CAD, patients with hypertension were more often male (p = 0.009), were older (p <0.001), had a higher BMI (p = 0.004), and had more frequently a history of hyperlipidemia (p <0.001) (Table 4). Coronary volume did not differ significantly between hypertensive and normotensive patients with obstructive CAD (3,026.4 ± 971.5 mm3 vs 2,937.5 ± 918.5 mm3, p = 0.058). Moreover, the LV mass was not significantly different between the 2 groups (123.6 ± 33.4 g vs 121.8 ± 29.4 g; p = 0.243). Accordingly, the V/M ratio was comparable between the 2 groups (25.2 ± 7.3 mm3/g vs 24.7 ± 7.2 mm3/g, p = 0.209). When we corrected for potential confounding variables, the epicardial coronary artery volume and myocardial mass were significantly higher in patients with hypertension than normotensive patients (LS mean difference estimate: 135.21 [95% CI 45.3 to 225.1] mm3, p = 0.003 and LS mean difference estimate: 4.92 [95% CI 2.30 to 7.55) g, p <0.001 respectively]; Figure 2, Table 5). However, the V/M ratio was not significantly different between the 2 groups (LS mean difference estimate: 0.15 [95% CI −0.54 to 0.84] mm3/g, p = 0.671).Table 4Baseline characteristics and coronary computed tomography and coronary computed tomography angiography parameters of patients with anatomically obstructive and without obstructive CAD according to hypertension statusObstructive CAD (≥50% DS)Without obstructive CAD (<50% DS)Total (n=1,663)Hypertension (n=968)No hypertension (n=695)p ValueTotal (n=711)Hypertension (n=376)No hypertension (n=335)p ValueBaseline patient characteristicsAge, (y) N1597930667<0.001672357315<0.001 Mean±SD66.6±10.368.0±9.664.6±10.765.0±10.767.2±9.562.4±11.4 Min, max26.0, 93.040.0, 93.026.0, 92.015.0, 90.034.0, 89.015.0, 90.0Male sex1,150 (69.2%)645 (66.6%)505 (72.7%)0.009412 (57.9%)203 (54.0%)209 (62.4%)0.024BMI, (kg/m2) N16489606880.0046953703250.006 Mean±SD25.9±4.526.2±4.625.5±4.226.4±5.226.9±5.425.9±4.8 Min, max14.9, 53.115.8, 53.114.9, 42.615.9,63.718.0, 63.715.9, 55.5Diamond forrester CAD likelihood N15859266590.6566633543090.206 Mean±SD53.2±20.053.0±20.053.4±19.945.6±19.046.5±18.944.6±19.2 Min, max8.0, 92.58.0, 92.58.0, 92.55.3, 92.58.0, 92.55.3, 88.9Hyperlipidemia Yes959 (57.7%)636 (65.7%)323 (46.5%)<0.001406 (57.1%)251 (66.8%)155 (46.3%)<0.001 No697 (41.9%)327 (33.8%)370 (53.2%)297 (41.8%)120 (31.9%)177 (52.8%) Unknown7 (0.4%)5 (0.5%)2 (0.3%)8 (1.1%)5 (1.3%)3 (0.9%)Rate of obstructive CAD per vesselLAD stenosis <50%354 (21.3%)206 (21.3%)148 (21.3%)0.995NANANANALAD stenosis ≥50%1,309 (78.7%)762 (78.7%)547 (78.7%)NANANALCX stenosis <50%1,145 (68.9%)652 (67.4%)493 (70.9%)0.120NANANANALCX stenosis ≥50%518 (31.1%)316 (32.6%)202 (29.1%)NANANARCA stenosis <50%1,045 (62.8%)585 (60.4%)460 (66.2%)0.017NANANANARCA stenosis ≥50%618 (37.2%)383 (39.6%)235 (33.8%)NANANACoronary volume - myocardial massEpicardial coronary artery volume (mm3) N16639686950.058711376335<0.001 Mean±SD2,989.2±950.53,026.4±971.52,937.5±918.53,172.9±1,017.13,305.8±1,019.13,023.8±995.4 Min, max704.6, 7,415.5732.1, 7,415.5704.6, 7,055.6889.6, 7,891.21,181.3, 7,891.2889.6, 7,198.4Left ventricle myocardial mass (g) N16639686950.2437113763350.074 Mean±SD122.9±31.8123.6±33.4121.8±29.4118.5±31.7120.5±31.1116.2±32.4 Min, max54.9, 324.154.9, 324.156.9, 247.158.3, 308.963.3, 264.658.3, 308.9Coronary volume / mass (mm3/g) N16639686950.2097113763350.007 Mean±SD25.0±7.325.2±7.324.7±7.227.3±7.628.1±7.926.5±7.2 Min, max6.8, 62.56.8, 59.27.2, 62.59.8, 61.910.7, 61.99.8, 51.0Data are presented as mean±standard deviation or number (percentage), as appropriate.BMI = body mass index; CAD = coronary artery disease; DS = diameter stenosis; LAD = left anterior descending artery; LCX = left circumflex artery; RCA = right coronary artery. Open table in a new tab Table 5Coronary computed tomography angiography parameters corrected for potential confounding variables in patients with obstructive CADModel effectLS mean difference (95% CI)p ValueTotal segmented volume Hypertension (yes/no)135.21 (45.3, 225.1)0.003 Age0.790 BMI<0.001 Hyperlipidemia (yes/no)0.002 Sex (male/female)<0.001 Number of vessels with obstructive CAD (0, 1, 2, 3)<0.001 Maximum stenosis % (≥50−≤70, >70−≤90, >90)<0.001Myocardial mass Hypertension (yes/no)4.92 (2.30, 7.55)<0.001 Age<0.001 BMI<0.001 Hyperlipidemia (yes/no)<0.001 Sex (male/female)<0.001 Number of vessels with obstructive CAD (0, 1, 2, 3)0.031 Maximum stenosis % (≥50−≤70, >70−≤90, >90)0.002Volume : mass ratio Hypertension (yes/no)0.15 (−0.54, 0.84)0.671 Age<0.001 BMI<0.001 Hyperlipidemia (yes/no)0.371 Sex (male/female)0.002 Number of vessels with obstructive CAD (0, 1, 2, 3)<0.001 Maximum stenosis % (≥50−≤70, >70−≤90, >90)<0.001BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; LS = least squares. Open table in a new tab Data are presented as mean±standard deviation or number (percentage), as appropriate. BMI = body mass index; CAD = coronary artery disease; DS = diameter stenosis; LAD = left anterior descending artery; LCX = left circumflex artery; RCA = right coronary artery. BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; LS = least squares. Hypertension was present in 376 of 711 patients (53%) without obstructive CAD. Patients with hypertension were more frequent female (p = 0.024), older (p <0.001), had a higher BMI (p = 0.006), and had more frequently a history of hyperlipidemia (p <0.001) (Table 4). Coronary volume was higher in patients with hypertension than normotensive patients without obstructive CAD (3,305.8 ± 1,019.1 mm3 vs 3,023.8 ± 995.4 mm, p <0.001), whereas LV mass did not differ significantly between the groups (120.5 ± 31.1 g vs 116.2 ± 32.4 g, p = 0.074). Consequently, the V/M ratio was significantly higher (2" @default.
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• W4377011660 title "Coronary Volume to Left Ventricular Mass Ratio in Patients With Hypertension" @default.
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