Both Current, Former Smoking Status Are Independently Associated With Low Coronary V/Ms in CAD Patients

Background: Smoking is a significant risk factor for coronary artery disease (CAD), progression of atherosclerosis, myocardial infarction, and cardiac death. Smoking cessation reduces cardiac risk and mortality. Increased cardiovascular risk associated with smoking may not be entirely explained by atherosclerotic burden and may reflect pathology not apparent at anatomic imaging, involving endothelial dysfunction, plaque composition, or coronary and myocardial remodeling. This is why much of the risk reduction associated with smoking cessation appears to occur in the initial years after quitting. Coronary volume-to-myocardial mass ratio (V/M) can be determined using CT fractional flow reserve (CT-FFR) analysis and is proposed as a quantitative measure of myocardial supply and demand. Normally, coronary luminal volume typically exhibits a strong linear relationship with myocardial mass but V/Ms can be reduced in microvascular angina, hypertrophic cardiomyopathy, and in CAD, low V/M is more...