Relation of left ventricular mass and concentric remodeling to extent of coronary artery disease by computed tomography in patients without left ventricular hypertrophy: ROMICAT study.
OBJECTIVE
Cardiac computed tomography allows for simultaneous assessment of left ventricular mass (LVM) and coronary artery disease (CAD). We aimed to determine whether LVM, LVM index (LVMi), and the left ventricular geometric pattern of concentric remodeling are associated with the extent of CAD in patients without left ventricular hypertrophy.


METHODS
In 348 patients from the Rule Out Myocardial Infarction Using Computer Assisted Tomography trial, 64-slice computed tomography was performed and LVM measured at end-diastole. We used three LVM indexation criteria to obtain three cohorts: LVM indexed to body surface area by echocardiography (n = 337) and computed tomography criteria (n = 325), and by height (n = 326). The cohorts were subdivided into concentric remodeling and normal geometry. Extent of coronary plaque was classified based on a 17-segment model, treated as a continuous variable, and stratified into three groups: zero segment, one to four segments, and more than four segments.


RESULTS
Patients with more than four segments of coronary plaque had higher LVM (Delta12.8-15.1 g) and LVMi (Delta4.0-5.5 g/m and Delta2.2 g/m) than those without CAD (all P < or = 0.03). After multivariable adjustment, LVM and LVMi remained independent predictors of extent of coronary plaque, with 0.27-0.29 segments more plaque per 20 g increase of LVM (all P = 0.02), 0.32-0.34 segments more plaque per 10 g/m increase of LVMi (both P = 0.02), and 0.80 segments more plaque per 10 g/m increase of LVMi (P = 0.008). Concentric remodeling patients had 1.1-1.3 segments more plaque than those with normal geometry (all P < or = 0.05). Patients with more than four segments of plaque had two-fold increase in odds (all P < or = 0.05) of having concentric remodeling as compared with those without CAD.


CONCLUSIONS
Increased LVM, LVMi, and concentric remodeling are associated with a greater degree of coronary plaque burden in patients without left ventricular hypertrophy. These findings could provide an indication to intensify medical therapy in patients with subclinical CAD and hypertension.
Truong
Quynh A
QA
Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. qtruong@partners.org
Toepker
Michael
M
Mahabadi
Amir A
AA
Bamberg
Fabian
F
Rogers
Ian S
IS
Blankstein
Ron
R
Brady
Thomas J
TJ
Nagurney
John T
JT
Hoffmann
Udo
U
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020257:Ventricular Remodeling; D055815:Young Adult
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