Risk stratification for myocardial ischemic events in type 2 diabetes mellitus (T2DM) remains challenging, particularly in patients without overt obstructive coronary artery disease (CAD). A retrospective study published in BMC Cardiovascular Disorders evaluated the prognostic value of the coronary volume to left ventricular mass ratio (V/M) derived from coronary computed tomography angiography (CCTA) in patients with T2DM.

The analysis included 306 patients (59.1% male; mean age 62.3 ± 10.6 years) with no prior myocardial infarction (MI) or coronary revascularization who underwent CCTA between January 2018 and 2019. CCTA parameters assessed included luminal diameter stenosis, total plaque volume, computed tomography–derived fractional flow reserve (CT-FFR), and V/M. The composite endpoint comprised all-cause mortality, nonfatal MI, unstable angina hospitalization, and late revascularization. Multivariable Cox regression models evaluated the independent prognostic value of V/M and its incremental contribution using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Over a median follow-up of 3.8 years, 107 patients (35%) experienced ischemic events, including 5 deaths, 22 myocardial infarctions, 62 angina hospitalizations, and 40 revascularizations. Obstructive CAD, total plaque volume >750 mm³, CT-FFR ≤0.80, and V/M were identified as independent predictors. V/M was associated with lower event risk per unit increase (HR 0.899, 95% CI 0.865-0.935; p<0.001). Addition of V/M improved risk stratification (NRI 0.173, p=0.044; IDI 0.057, p<0.001). Subgroup analyses showed consistent associations in both obstructive and non-obstructive CAD.

These findings indicate that CCTA-derived V/M is independently associated with ischemic event risk and provides incremental prognostic value beyond established imaging parameters in patients with T2DM.