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Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease

Tijn P J Jansen1, Suzette E Elias-Smale1, Stijn van den Oord1

  • 1Department of Cardiology, Radboudumc, Nijmegen, Netherlands.

Frontiers in Cardiovascular Medicine
|November 1, 2021
PubMed

Insights

Men and women with angina and no obstructive coronary artery disease (ANOCA) show similar rates of coronary vasomotor dysfunction. However, men exhibit more epicardial spasm, while women present with more microvascular dysfunction and impaired coronary flow reserve (CFR).

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Testing

Background:

  • Coronary function testing (CFT) is crucial for diagnosing coronary vasomotor dysfunction in patients with angina and no obstructive coronary artery disease (ANOCA).
  • Understanding sex-related differences in CFT results is essential for tailored therapeutic strategies and improved prognosis.
  • Limited data exists on sex-specific outcomes from comprehensive CFT assessments.

Purpose of the Study:

  • To investigate sex-related differences in the prevalence and patterns of coronary vasomotor dysfunction identified by comprehensive coronary function testing (CFT) in patients with ANOCA.
  • To compare the incidence of epicardial spasm, microvascular spasm, coronary flow reserve (CFR), and index of microvascular resistance (IMR) between men and women.

Main Methods:

  • Prospective study of consecutive patients with ANOCA undergoing clinically indicated CFT (acetylcholine and adenosine testing) from February 2019 to February 2021.
  • Coronary microvascular dysfunction (CMD) defined by index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) < 2.0.
  • Comparison of clinical characteristics, CFT results, and specific dysfunction endotypes between male and female patients.

Main Results:

  • A total of 228 women and 38 men were analyzed; no significant differences in traditional risk factors were observed.
  • Overall coronary vasomotor dysfunction prevalence was high and similar between sexes (95% in men vs. 88% in women).
  • Men showed significantly higher rates of epicardial spasm (63% vs. 42%) and lower rates of microvascular spasm (29% vs. 40%) compared to women (p=0.039).
  • Women had a higher prevalence of impaired CFR (20% vs. 6%, p=0.033), while IMR did not differ significantly between sexes.

Conclusions:

  • Men and women with ANOCA exhibit comparable overall prevalence of coronary vasomotor dysfunction.
  • Distinct patterns of dysfunction exist, with men more frequently experiencing epicardial spasm and women showing a higher incidence of microvascular spasm and impaired CFR.
  • These sex-specific findings highlight the need for tailored diagnostic and therapeutic approaches in managing ANOCA.

Keywords:
ANOCACFRIMRcoronary function testmicrovascular dysfunctionsexvasospasm

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