Left Ventricular Mass to Coronary Blood Volume Ratio in Discrimination of Hypertrophic Phenotypes: Hypertrophic Cardiomyopathy and Hypertensive Heart Disease

Ashraf Hamdan 1 Ehud Schwammenthal 2 Monakier Daniel 1 Ariel Gutstein 1 Gideon Shafir 3 Abid Assali 1 Ran Kornowski 1
1Department of Cardiology, Rabin Medical Center
2Department of Cardiology, Sheba Medical Center
3Department of Diagnostic Imaging, Rabin Medical Center

Background: A mismatch between increased left ventricular (LV) mass (LVM) and blood supply may reduce coronary flow reserve, and lead to myocardial ischemia and symptoms in patients with left ventricular hypertrophy caused by hypertrophic cardiomyopathy (HCM) and increased LV wall thickness because of systemic hypertension.

Objectives: To compare LVM to coronary blood volume (CBV) ratio in patients with HCM and hypertensive heart disease, aged normal subjects were selected.

Methods: Nineteen patients with HCM, 18 patients with secondary hypertrophy and 16 healthy volunteers underwent retrospective electrocardiography triggered 256-slice computed tomography (CT). The 3D data set of the contrast-enhanced CT scan was reconstructed using iterative model reconstruction and transmitted to a dedicated CT workstation. LVM and LV end-diastolic volume (LVEDV) were calculated and the entire coronary tree was automatically detected to calculate CBV. LVM/CBV ratio was calculated and compared between patients with HCM, patients with hypertensive heart disease and normal subjects.

Results: Patients with HCM had higher LVM index compared to patients with hypertensive heart disease and normal subjects (119.4 ± 39.5 g/m2, 67.5 ± 14.9 g/m2, 52.3 ± 9.7 g/m2 ;respectively, P < 0.001), and higher CBV index (3.5 cc/m2 ± 1.1 vs. 2.5 ± 0.6 cc/m2, 2.1 ± 0.5 cc/m2; respectively, P < 0.001). Despite increased CBV in patients with HCM, LVM/CBV ratio was significantly higher compared to patients with hypertensive heart disease and normal subjects (34.9 ± 6.5, 27.4 ± 4.2, 25.5 ± 3.2; respectively, P < 0.001). LVM/CBV ratio was an independent discriminator between HCM and hypertensive heart disease, over and above LVEDV, LV wall thickness and indexed LV mass.

Conclusion: LVM/CBV ratio may be applied to discriminate between HCM and hypertensive heart disease and may be useful to detect early myocardial ischemia as expressed by imbalance between muscle mass and coronary blood supply.









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