Vessel-Specific Myocardial Mass in Patients With Stable Coronary Artery Disease

Abstract

Background: Assessing the myocardial mass at risk is essential in evaluating patients with coronary artery disease. This study aims to establish reference values for vessel-specific myocardial mass derived from coronary computed tomography angiography, providing a quantitative assessment of the myocardial mass subtended by each epicardial vessel.

Methods: Left ventricular (LV) and vessel-specific myocardial mass were calculated from coronary computed tomography angiography using the Voronoi method in patients with stable coronary artery disease. Myocardial mass was quantified for each epicardial coronary artery with a diameter >1.5 mm.

Results: We included 948 patients with 9228 epicardial coronary artery branches. Mean age was 66±9 years. The cohort was predominantly male (77%); 66% had hypertension, and 22% had diabetes. Vessel-specific myocardial mass was calculated for 2767 main epicardial arteries (948 left anterior descending, 948 left circumflex, and 871 right coronary artery) and 6461 side branches (1888 diagonals, 1208 septals, 1422 obtuse marginals, 247 ramus intermedius, 850 right posterior descending, and 846 posterolateral branches). Median LV mass was 141 grams (interquartile range 118-166); women had smaller LV mass than men (106 [93-123] grams versus 150 [132-173] grams, P<0.001). On average, the left anterior descending subtended 42.5% [37.9-48.1] of LV mass, the left circumflex artery 28.8% [21.9-5.7], and the right coronary artery 26.4% [20.9-31.9]. Median LV mass subtended by the first septal, first diagonal, and first obtuse marginal were 8.9% [6.4-11.1], 7.9% [4.52-2.0], and 10.2% [4.52-12.0], respectively.

Conclusions: This study quantified the myocardial mass subtended by each major artery in the coronary circulation. Understanding the vessel-specific mass at risk has significant clinical implications for personalizing revascularization strategies.

Registration: This is a retrospective analysis of 5 prospectively conducted trials (P3: NCT03782688; P4: NCT05253677; PPG Global: NCT04789317; Euro-CRAFT: NCT05805462; INSIGHTFUL-FFR: NCT05437900). No additional registration was required.

Keywords: coronary CT angiography; coronary artery disease; myocardial mass; vessel‐specific analysis.