Smoking associated with lower coronary volume-to-myocardial mass ratio, study shows

"Smoking is associated with lower coronary volume-to-myocardial mass ratio in individuals with coronary artery disease (CAD)," the researchers reported. The findings further cement the link between smoking and heart disease.

Current and former smoking were independently associated with lower V/M in participants with coronary artery disease, the researchers noted.

Previous studies have shown that a low volume-to-myocardial mass ratio is associated with conditions such as hypertrophic cardiomyopathy microvascular angina, and coronary artery disease, with greater stenosis. However, the effect of smoking volume-to-myocardial mass ratio has not been thoroughly established. To fill this knowledge gap, Kenneth R. Holmes, University of British Columbia, Vancouver, BC, Canada, and colleagues aimed to investigate the relationship between smoking status and coronary V/M among individuals with CAD undergoing CT fractional flow reserve analysis.

The secondary analysis included participants from the ADVANCE registry evaluated for suspected CAD from 2015 to 2017, who were found to have coronary stenosis of 30% or a greater at coronary CT angiography (CCTA) if they had known smoking status and underwent CT-FFR and V/M analysis.

CCTA images were segmented to calculate myocardial mass and coronary volume. V/M was compared between smoking groups, and predictors of low V/M were determined.

The sample for analysis consisted of 503 current smokers, 1060 former smokers, and 1311 never-smokers (2874 participants; 1906 male participants).

The study led to the following findings:

• After adjustment for clinical and demographic factors, former smokers had greater coronary volume than never-smokers (former smokers, 3021.7 mm3 ± 934.0 [SD]; never-smokers, 2967.6 mm3 ± 978.0), while current smokers had increased myocardial mass compared with never-smokers (current smokers, 127.8 g ± 32.9; never-smokers, 118.0 g ± 32.5).
• Both current and former smokers had lower V/M than never-smokers (current smokers, 24.1 mm3/g ± 7.9; former smokers, 24.9 mm3/g ± 7.1; never-smokers, 25.8 mm3/g ± 7.4).
• Current smoking status (odds ratio [OR], 0.74), former smoking status (OR, 0.81), stenosis of 50% or greater (OR, 0.62), and diabetes (OR, 0.67) were independent predictors of low V/M.

In conclusion, history of smoking (current or former smoking status) was an independent predictor of low V/M derived from CT-FFR,

"Mechanisms driving low V/M in smokers and the potential use of V/M as a surrogate marker of vascular health and predictor of downstream clinical outcomes require further study.

Reference:

Holmes KR, Gulsin GS, Fairbairn TA, Hurwitz-Koweek L, Matsuo H, Nørgaard BL, Jensen JM, Sand NR, Nieman K, Bax JJ, Pontone G, Chinnaiyan KM, Rabbat MG, Amano T, Kawasaki T, Akasaka T, Kitabata H, Rogers C, Patel MR, Payne GW, Leipsic JA, Sellers SL. Impact of Smoking on Coronary Volume-to-Myocardial Mass Ratio: An ADVANCE Registry Substudy. Radiol Cardiothorac Imaging. 2024 Apr;6(2):e220197. doi: 10.1148/ryct.220197. PMID: 38483246.