Related Experiment Video
Updated: Jan 22, 2026
Z-Scores for Assessing Ovarian Reserve in Young Patients Undergoing Fertility Preservation
Published on: October 25, 2024
Heart rate reserve is a long-term risk predictor in women undergoing myocardial perfusion imaging
Caroline E Gebhard1,2, Monika Marędziak1,3, Angela Portmann1,3
1Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Insights
Reduced heart rate reserve during vasodilator stress is a strong predictor of adverse cardiovascular events in women. This finding highlights a unique female determinant of cardiovascular risk, improving long-term outcome prediction.
Area of Science:
- Cardiology
- Cardiovascular Disease Research
- Medical Imaging
Background:
- Women with cardiovascular disease (CVD) face worse outcomes than men.
- Unique female determinants of cardiovascular risk require further investigation.
- Heart rate (HR) responses to vasodilator stress may indicate autonomic activity and prognosis in women.
Purpose of the Study:
- To investigate the prognostic value of heart rate reserve (HRR) during vasodilator stress in predicting cardiovascular events in women.
- To compare HRR responses and their prognostic implications between men and women undergoing cardiac imaging.
Main Methods:
- Adenosine stress hemodynamic data were collected from 508 patients undergoing 13N-ammonia Positron-Emission-Tomography (PET).
- Propensity matching created a cohort of 202 patients (101 women) for analysis.
- Cox regression and ROC curve analyses assessed the association between HRR and cardiovascular endpoints over a median 5.6-year follow-up.
Main Results:
- Women exhibited significantly higher HRR during adenosine stress compared to men (23.8% vs 17.3%, p=0.009).
- A blunted HRR (<21%) was a strong predictor of major adverse cardiac events (MACE) in women (HR 2.41, p=0.011), with 77% sensitivity and 68% specificity.
- Reduced HRR was a more pronounced predictor of cardiovascular endpoints in women than in men.
Conclusions:
- Blunted heart rate reserve during adenosine stress provides incremental prognostic value for long-term cardiovascular outcomes in women.
- HRR assessment during vasodilator stress can enhance risk stratification beyond traditional factors and imaging findings in female patients.
- This study identifies a novel, sex-specific predictor for cardiovascular risk in women.
Background:
Although women with cardiovascular disease experience relatively worse outcomes as compared to men, substantial knowledge gaps remain regarding the unique female determinants of cardiovascular risk. Heart rate (HR) responses to vasodilator stress mirror autonomic activity and may carry important long-term prognostic information in women.
Methods And Results:
Hemodynamic changes during adenosine stress were recorded in a total of 508 consecutive patients (104 women) undergoing clinically indicated 13N-ammonia Positron-Emission-Tomography (PET) at our institution. Following propensity matching, 202 patients (101 women, mean age 61.3 ± 12.6 years) were analyzed. During a median follow-up of 5.6 years, 97 patients had at least one cardiac event, including 17 cardiac deaths. Heart rate reserve (% HRR) during adenosine infusion was significantly higher in women as compared to men (23.8 ± 19.5 vs 17.3 ± 15.3, p = 0.009). A strong association between 10-year cardiovascular endpoints and a blunted HRR was observed in women, while this association was less pronounced in men. Accordingly, in women, but not in men, reduced HRR was selected as a strong predictor for adverse cardiovascular events in a Cox regression model fully adjusted for imaging findings and traditional risk factors (HR 2.41, 95% CI 1.23-4.75, p = 0.011). Receiver operating characteristics (ROC) curves revealed that a blunted HRR <21% was a powerful predictor for MACE in women with a sensitivity of 77% and a specificity of 68%.
Conclusion:
Blunted HRR to adenosine stress adds incremental prognostic value for long-term cardiovascular outcomes in women beyond that provided by traditional risk factors and imaging findings.
Related Concept Videos
01:31Regulation of Heart Rates
The SNS increases heart rate through the release of norepinephrine and epinephrine, which act on beta-1 adrenergic receptors in the heart. This action increases the rate of depolarization in the sinoatrial (SA) node, the heart's...
01:30Factors Influencing Heart Rate
Let us explore the significant factors affecting heart rate, including age, body temperature, posture, acute pain, chemical influences,...
01:15Factors Affecting Drug Distribution: Organ Perfusion Rate
Perfusion rate-limited distribution relies on the...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...
02:53Reaction Rate
The mathematical representation of the change in the concentration of reactants and products, over time, is the rate...
01:12Relative Risk