Sex differences in contributors to coronary microvascular dysfunction

Abstract

BackgroundCoronary microvascular dysfunction (CMD) has differences in prevalence and presentation between women and men; however, we have limited understanding about underlying contributors to sex differences in CMD. Myocardial perfusion reserve index (MPRI), as semi-quantitative measure of myocardial perfusion derived from cardiac magnetic resonance (CMR) imaging has been validated as a measure of CMD. We sought to understand the sex differences in the relations between the MPRI and traditional measures of cardiovascular disease by CMR.MethodsA retrospective analysis of a single-center cohort of patients receiving clinical stress CMR from 2015 to 2022 was performed. Patients with calculated MPRI and no visible perfusion defects consistent with obstructive epicardial coronary disease were included. We compared associations between MPRI versus traditional cardiovascular risk factors and markers of cardiac structure/function in sex-stratified populations using univariable and multivariable regression models.ResultsA total of 229 patients [193 female, 36 male, median age 57 (47–67) years] were included in the analysis. In the female population, no traditional cardiovascular risk factors were associated with MPRI, whereas in the male population, diabetes (β: −0.80, p = 0.03) and hyperlipidemia (β: −0.76, p = 0.006) were both associated with reduced MPRI in multivariable models. Multivariable models revealed significant associations between reduced MPRI and increased ascending aortic diameter (β: −0.42, p = 0.005) and T1 times (β: −0.0056, p = 0.03) in the male population, and increased T1 times (β: −0.0037, p = 0.006) and LVMI (β: −0.022, p = 0.0003) in the female population.ConclusionThe findings suggest different underlying pathophysiology of CMD in men versus women, with lower MPRI in male patients fitting a more “traditional” atherosclerotic profile.

Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function

“…Third, the INOCA controls were numerically, but not statistically, younger than the TTS patients in our study, which could have influenced the differences in CMD between groups. CMD has however not been associated with age in previous studies 15,25 . Fourth, intravascular and cardiac imaging was not performed in the INOCA control group.…”

“…However, the lack of association between CMD and measures of coronary atherosclerosis in our study contradicts that theory. CMD in women was also unrelated to traditional cardiovascular risk factors in a study by Kwan et al 25 …”

“…However, the lack of association between CMD and measures of coronary atherosclerosis in our study contradicts that theory. CMD in women was also unrelated to traditional cardiovascular risk factors in a study by Kwan et al 25 Sans-Roselló et al 9 recently showed that CMD in TTS was associated with both EF on echocardiography and NT-proBNP levels in a study with non-hyperaemic angiography-derived IMR assessment of all three coronary arteries. In our study, CFR and RRR, but not IMR, were associated with EF, which could be due to our smaller sample size and methodological differences.…”

“…CMD has however not been associated with age in previous studies. 15,25 Fourth, intravascular and cardiac imaging was not performed in the INOCA control group. Finally, our study cannot provide causative evidence of CMD as the underlying pathophysiological mechanism of TTS.…”

Development and validation of a nomogram for predicting overall survival of patients with ischemic cardiomyopathy and heart failure: a post-hoc analysis of the Surgical Treatments for Ischemic Heart Failure (STICH) trail

“…21 On the contrary, multiple lines of evidence have documented the poorer prognosis of female compared to male due to various pathologic resultant such as medical co-morbid conditions, coronary microvascular dysfunction and diastolic filling pattern. [22][23][24] . However, the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization highlighted that treatment decisions for patients with CAD requiring revascularization should be based on clinical indications, regardless of gender, race, or ethnicity in an effort to mitigate disparities of care.…”