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Differences in Plaque Characteristics and Myocardial Mass: Implications for Physiological Significance
Chee Hae Kim1, Seokhun Yang2, Jinlong Zhang3
1Department of Internal Medicine and Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea.
JACC. Asia
|November 7, 2022
Summary
Women have higher fractional flow reserve (FFR) values than men for similar coronary stenosis severity. This is due to less high-risk plaque and smaller heart muscle mass in women.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Imaging
Background:
- The underlying mechanisms contributing to sex-based differences in fractional flow reserve (FFR) remain incompletely understood.
- Investigating these differences is crucial for accurate diagnosis and treatment of coronary artery disease (CAD) in both men and women.
Purpose of the Study:
- To evaluate sex-specific variations in coronary stenosis severity, plaque composition, and left ventricular (LV) mass.
- To determine the impact of these variations on the physiological significance of coronary lesions as measured by FFR.
Main Methods:
- A post hoc analysis of pooled data from international prospective cohorts.
- Coronary computed tomography angiography (CCTA) and invasive FFR measurements were performed in 166 women and 489 men.
- Analysis included minimal lumen area, plaque burden, plaque composition, high-risk plaque characteristics, and LV mass.
Main Results:
- Women exhibited higher FFR values (0.85 ± 0.13) compared to men (0.82 ± 0.14) despite similar diameter stenosis.
- Women had lower percentages of fibrofatty plaque + necrotic core, low attenuation plaque, and positive remodeling.
- While vessel, plaque, and lumen volumes were smaller in women, these differences disappeared after adjusting for LV mass.
Conclusions:
- Higher FFR in women with equivalent stenosis is attributed to a lower burden of high-risk plaque characteristics.
- Smaller myocardial mass in women also contributes to the observed sex differences in FFR.
- Sex is not an independent predictor of FFR when accounting for stenosis severity, plaque characteristics, and LV mass.
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