Associations among Coronary Artery Calcium Score, Left Ventricular Mass Index and Septal E/E’ Ratio in Subjects with Normal Left Ventricular Ejection Fraction

Background: The objective of this study is to determine if associations among the coronary artery calcium (CAC) score (CACS), left ventricular mass index (LVMI), and septal E/E’ ratio. Methods: We investigated 1230 consecutive subjects with a normal left ventricular ejection fraction who underwent multidetector computed tomography and echocardiography. The CACS was measured using the Agatstone method. Participants were classified as follows, in a two-fold manner: first, negative CAC (CACS=0) group and positive CAC (CACS ＞0) group; second, no (CACS=0), mild (1-100), moderate (101-400), and severe CAC deposits (＞400). Results: In multivariate binary logistic regression adjusted for covariates, the LVMI and septal E/E’ ratio were independent predictors of positive CAC deposits (CACS ＞0) and severe CACS (CACS ＞400). Regarding the “composite score” based on a septal E/E’ ratio ≥15 and LVMI ≥90 g/m2, a higher score was associated with a greater CACS. Per the severity criteria of the CACS, severe CAC deposits were significantly associated with “composite score 2” group and the odds ratios in each group were 1.790, 2.126, and 5.705, respectively. Conclusion: In our study, the LVMI and septal E/E’ ratio were associated with the CACS, independent of classic risk factors in patients with chest pain or without symptoms with a normal left ventricular ejection fraction.