Females have higher myocardial perfusion, blood volume and extracellular volume compared to males – an adenosine stress cardiovascular magnetic resonance study

Abstract

Knowledge on sex differences in myocardial perfusion, blood volume (MBV), and extracellular volume (ECV) in healthy individuals is scarce and conflicting. Therefore, this was investigated quantitatively by cardiovascular magnetic resonance (CMR). Healthy volunteers (n = 41, 51% female) underwent CMR at 1.5 T. Quantitative MBV [%] and perfusion [ml/min/g] maps were acquired during adenosine stress and at rest following an intravenous contrast bolus (0.05 mmol/kg, gadobutrol). Native T1 maps were acquired before and during adenosine stress, and after contrast (0.2 mmol/kg) at rest and during adenosine stress, rendering rest and stress ECV maps. Compared to males, females had higher perfusion, ECV, and MBV at stress, and perfusion and ECV at rest (p < 0.01 for all). Multivariate linear regression revealed that sex and MBV were associated with perfusion (sex beta −0.31, p = 0.03; MBV beta −0.37, p = 0.01, model R2 = 0.29, p < 0.01) while sex and hematocrit were associated with ECV (sex beta −0.33, p = 0.03; hematocrit beta −0.48, p < 0.01, model R2 = 0.54, p < 0.001). Myocardial perfusion, MBV, and ECV are higher in female healthy volunteers compared to males. Sex is an independent contributor to perfusion and ECV, beyond other physiological factors that differ between the sexes. These findings provide mechanistic insight into sex differences in myocardial physiology.

The Effects of Biological Sex on Sepsis Treatments in Animal Models: A Systematic Review and a Narrative Elaboration on Sex- and Gender-Dependent Differences in Sepsis

“…The neural-hemodynamic balance between cardiac output and peripheral resistance, mediated by the sympathetic nervous system, appears to have important sex-dependent differences with consequential effects for blood pressure regulation under healthy and diseased conditions ( 135 , 136 ). From a cardiac performance standpoint, healthy females appear to have higher myocardial perfusion ( 137 ), cardiac strain ( 138 ), cardiac flow dynamics ( 139 ), and more favorable LV twist mechanics following acute reductions in preload ( 140 ). These considerations may explain the differing hemodynamic responses encountered by healthy men and women following exposure to endotoxin.…”

Cardiac stress T1-mapping response and extracellular volume stability of MOLLI-based T1-mapping methods

“…One female participant in our cohort demonstrated a sustained stress response, with dT1 persisting near peak over the entire stress period. Although we did not specifically analyze sex differences, this may have contributed, with Nickander et al recently showing higher stress MBV in females compared with males 46 . Bodyweight may also be a consideration (62 kg; BMI 23.9 in this case), given the one-size-fits-all regadenoson dosing protocol.…”

Cardiovascular magnetic resonance stress and rest T1-mapping using regadenoson for detection of ischemic heart disease compared to healthy controls

“…Additionally, there may be potential sex bias given the majority (92%) of our CAD cohort were male, compared with the controls (50%). This is potentially relevant given higher quantitative perfusion and MBV in female healthy volunteers during adenosine stress [ 31 ], although no significant sex differences in the diagnostic performance of CMR have been reported [ 32 ]. Further work with larger cohorts is required to study the effects of sex on stress T1 reactivity.…”