Ethnic differences in coronary anatomy,left ventricular mass and CT-derived fractional flow reserve |
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| Authors: | Abdul Rahman Ihdayhid Udit Thakur Grace Yap Markus Goeller Nitesh Nerlekar Daniel Adams Mourushi Isa Mitwa Joshi James Cameron Sujith Seneviratne Damini Dey Stephan Achenbach Jonathan Leipsic Brian S Ko |
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| Institution: | 1. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan;2. Department of Molecular Pathology, Hiroshima University Institute of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan;3. Department of Pathology, National Hospital Organization Higashi-Hiroshima Medical Center, 513 Saijojike, Higashi, Hiroshima, 739-0041, Japan;4. Department of Cardiovascular Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan;5. Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-Ku, Kobe, 650-0047, Japan;1. Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA;2. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA;3. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA;4. Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA;1. Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Cardiology, Erlangen, Germany;2. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA |
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| Abstract: | BackgroundStudies have observed higher incidence of cardiovascular mortality in South Asians (SA), and lower prevalence in East Asians (EA), compared with Caucasians. These observations are not entirely explained by ethnic differences in cardiovascular risk factors and mechanistic factors such as variations in cardiac anatomy and physiology may play a role. This study compared ethnic differences in CT-assessed left ventricular (LV) mass, coronary anatomy and non-invasive fractional flow reserve (FFRCT).MethodsThree-hundred symptomatic patients (age 59 ± 7.9, male 51%) underwent clinically-mandated CT-coronary-angiography (CTA) were matched for age, gender, BMI and diabetes (100 each ethnicity). Assessment of coronary stenosis, luminal dimensions and vessel dominance was performed by independent observers. LV mass, coronary luminal volume and FFRCT were quantified by blinded core-laboratory. A sub-analysis was performed on patients (n = 187) with normal/minimal disease (0–25% stenosis).ResultsStenosis severity was comparable across ethnic groups. EA demonstrated less left-dominant circulation (2%) compared with SA (8.2%) and Caucasians (10.1%). SA compared with EA and Caucasians demonstrated smallest indexed LV mass, coronary luminal volumes and dimensions. EA compared with Caucasians had comparable indexed LV mass, coronary luminal dimensions and highest luminal volumes. The latter was driven by higher prevalence of right-dominance including larger and longer right posterior left ventricular artery. FFRCT in the left anterior descending artery (LAD) was lowest in SA (0.87) compared with EA (0.89; P = 0.009) and Caucasians (0.89; P < 0.001), with no difference in other vessels. All observed differences were consistent in patients with minimal disease.ConclusionThis single-centre study identified significant ethnic differences in CT-assessed LV mass, coronary anatomy and LAD FFRCT. These hypotheses generating results may provide a mechanistic explanation for ethnic differences in cardiovascular outcomes and require validation in larger cohorts. |
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| Keywords: | Computerized tomography (CT) Race and ethnicity Coronary artery dominance Left ventricular mass Fractional flow reserve |
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