Background <p>The ratio of coronary artery volume to left ventricular myocardial mass (V/M) reflects the hemodynamic association between epicardial coronary arteries and myocardium. Evidence suggests a significant decrease in V/M among patients with primary microvascular angina (PMVA). However, V/M values may be influenced by anatomic and physiological varieties, necessitating independent evaluation in different ethnic groups. We aimed to explore the potential of V/M in predicting PMVA in Chinese population.</p> Methods <p>We conducted a retrospective case-control analysis on 23 PMVA patients and 25 controls matched by age, sex, body mass index, smoking history, hypertension, diabetes, and dyslipidemia. For each patient, the computed tomography (CT) images were three-dimensionally reconstructed to calculate patient-specific V/M and vessel-specific V/M, as well as CT-derived fractional flow reserve (CT-FFR). The results in both groups were compared using t-test or Mann-Whitney U test.</p> Results <p>Compared to the control group, the PMVA group had significantly higher total myocardial mass and lower average V/M (<i>P</i> &lt; 0.05 for both). Regarding vessel-specific V/M, PMVA group had significantly lower values of left anterior descending artery and left circumflex artery (<i>P</i> &lt; 0.05 for both), with no significant inter-group difference in right coronary artery (<i>P</i> &gt; 0.05). There was no significant difference between two groups in vessel-specific CT-FFR (<i>P</i> &gt; 0.05 for all).</p> Conclusion <p>The abnormally decreased V/M value may serve as a potential biomarker of PMVA in Chinese population.</p>