Myocardial demand-supply imbalance: a propensity-matched analysis of normal-range increased left ventricular mass

Abstract

Abstract Purpose: Increased left ventricular myocardial mass index (LVMMI) raises mortality risk due to varied cardiovascular complications, the underlying etiology of which revolves around the decreased left ventricular ejection fraction (LVEF), hence heart failure. We hypothesized that increased LVMMI assessed with cardiac computed tomography (CT), along with increased end-diastolic volume index (EDVI) and interventricular septal wall thickness at diastole (IVSd), were associated with chest discomfort in patients with normal coronary arteries. Methods We retrospectively enrolled 130 patients who had undergone coronary CT angiography in our center between 2018 and 2020. Only normal coronary patients without coexisting medical conditions were recruited in groups with and without chest discomfort. We performed propensity-score matching (PSM) to produce matched groups. Using the previous CT data, we calculated LVMMI, EDVI, and IVSd and compared them between the groups. Results After PSM, the LVMMI was significantly higher in the group with chest discomfort both in the total population and in the females, but not in the males (OR=1.04, 95% CI 1.00-1.08, p-value=0.021 and OR=1.11, 95% CI 1.03-1.19, p-value=0.003, for the total population and the females, respectively). EDVI and IVSd were not significantly different between the groups. Moreover, the receiver operator characteristics (ROC) curve analysis showed a significant diagnostic accuracy of LVMMI in the females for chest discomfort (p-value<0.001). Conclusion We proposed that the increased cardiac CT-derived LVMMI within the normal range, is a potential predictor of chest discomfort due to myocardial demand-supply imbalance, at least in females. Further research is required to establish the results.