Correlation between coronary plaque burden and heart weight

It is unclear if the extent of coronary atherosclerosis is associated with increase in heart muscle mass. We retrospectively reviewed autopsy reports of sudden coronary deaths occurring in a statewide medical examiner system over a one-year period. Cardiomegaly was assessed by height, and given a score of 0-4 based on amount above the upper limit of normal range. Coronary disease was quantitated as number of epicardial arteries with ≥75% cross sectional luminal narrowing. There were 100 hearts with one-vessel disease, 77 with two-vessel disease, and 59 with three- or four-vessel diseases. The extent of disease was less in women than men (P=0.002). Healed infarcts were present in 21% of women and 36% of men. Cardiomegaly was present in 50% of women and 69% of men. By univariate analysis, in patients without hypertension, cardiomegaly score in the three- or four-vessel disease group was significantly greater than in the one-vessel disease group (P=0.005), as well as the frequency of cardiomegaly (P=0.001). Hearts with myocardial scar had a more frequent cardiomegaly (P=0.0004) and higher cardiomegaly score (P=0.004) than without myocardial scar. Moreover, by multivariate analysis, body mass index (P<0.0001), extent of coronary disease (P=0.02) and healed infarct (P=0.04) were positively associated with cardiomegaly. We conclude that there is a significant correlation between the extent of coronary atherosclerosis and cardiac hypertrophy independent of age and body mass index in sudden coronary deaths as well as healed infarct. These data support a causative association between chronic ischemia and cardiomegaly.