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Sex-specific differences in coronary blood flow and flow velocity reserve in symptomatic patients with
Michel T Corban1, Abhiram Prasad, Rajiv Gulati
1Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Insights
Women with chest pain and non-obstructive coronary artery disease show lower coronary flow velocity reserve (CFVR) and altered coronary blood flow (CBF) compared to men. Female sex is a predictor of these sex-specific coronary physiology differences.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Diagnostics
Background:
- Reduced coronary flow velocity reserve (CFVR) is linked to adverse cardiovascular outcomes.
- Sex-based differences in coronary physiology, particularly in patients with chest pain and non-obstructive coronary artery disease (CAD), are not well understood.
Purpose of the Study:
- To investigate potential sex differences in CFVR and coronary blood flow (CBF) among patients with chest pain and non-obstructive CAD.
- To determine if female sex is an independent predictor of differences in coronary vasomotion.
Main Methods:
- Analysis of 1,683 patients with ischaemia symptoms and <40% coronary artery stenosis.
- Measurement of CFVR (hyperaemic/resting velocity), quantitative angiography for LAD diameter, and calculation of resting (rCBF) and hyperemic (hCBF) coronary blood flow.
- Calculation of resting microvascular resistance (rMR).
Main Results:
- Women (65%) had significantly lower CFVR, higher resting CBF (rCBF), and lower hyperemic CBF (hCBF) compared to men.
- No significant difference in resting microvascular resistance (rMR) was observed between sexes.
- Female sex independently predicted lower CFVR, higher rCBF, and lower hCBF.
Conclusions:
- Women with ischaemia symptoms and non-obstructive CAD exhibit distinct coronary physiological responses compared to men.
- These sex-specific differences in CFVR and CBF highlight the need for further research into their clinical and prognostic implications.
- Female sex is a significant predictor of these observed coronary physiological variations.
Aims:
Reduced coronary flow velocity reserve (CFVR) is associated with adverse cardiovascular outcomes. Whether CFVR and coronary blood flow (CBF) are similar in men and women with chest pain and non-obstructive CAD remains unknown. We hypothesised sex differences in CFVR and CBF.
Methods And Results:
A total of 1,683 patients with signs/symptoms of ischaemia and angiographically unobstructed coronary arteries (<40% angiographic stenosis) underwent coronary vasomotion evaluation. CFVR was measured as hyperaemic/resting average velocity in the LAD. Mid-LAD diameter was measured with quantitative angiography and CBF calculated at rest (rCBF) and hyperaemia (hCBF). Resting microvascular resistance (rMR) was calculated as mean arterial pressure/rCBF. Of the total number of patients, 1,096 (65%) were women, median age 51 [42, 59] years. Compared to men, women had lower median CFVR (2.7 [2.4, 3.2] vs 3.1 [2.7, 3.6], p<0.001), higher rCBF (49.7 [34.0, 71.1] vs 45.9 [31.8, 68.7] ml/min, p=0.04), lower hCBF (139.5 [93.0, 195.2] vs 147.1 [95.7, 218.6] ml/min, p=0.02), but similar rMR (p=0.82). Female sex was an independent predictor of lower CFVR, higher rCBF, and lower hCBF.
Conclusions:
Compared to men, women with signs/symptoms of ischaemia and non-obstructive CAD have lower CFVR, higher rCBF, and lower hCBF. Female sex is a predictor of these sex-specific differences. The clinical diagnostic and prognostic implications of sex differences in coronary physiology need further evaluation.
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