Effect of Sex Differences on Invasive Measures聽of聽Coronary Microvascular Dysfunction聽in聽Patients With Angina in聽the聽Absence聽of Obstructive Coronary Artery聽Disease

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• 作者：Yuhei Kobayashi ; MD ; William F. Fearon ; MD ; Yasuhiro Honda ; MD ; Shigemitsu Tanaka ; MD ; Vedant Pargaonkar ; MBBS ; Peter J. Fitzgerald ; MD ; PhD ; David P. Lee ; MD ; Marcia Stefanick ; PhD ; Alan C. Yeung ; MD ; Jennifer A. Tremmel ; MD ; MS ; ^{jtremmel@stanford.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：coronary flow reserve ; coronary microvascular resistance ; physiology ; sex
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：8
• 期：11
• 页码：1433-1441
• 全文大小：903 K

文摘

This study investigated sex differences in coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients with angina in the absence of obstructive coronary artery disease.

Background

Coronary microvascular dysfunction is associated with worse long-term outcomes, especially in women. Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are 2 methods of assessing the coronary microcirculation.

Methods

We prospectively enrolled 117 women and 40 men with angina in the absence of obstructive coronary artery disease. We performed CFR, IMR, fractional flow reserve, and quantitative coronary angiography in the left anterior descending artery. Coronary flow was assessed with a thermodilution method by obtaining mean transit time (T_mn) (an inverse correlate to absolute flow) at rest and hyperemia.

Results

All patients had minimal atherosclerosis by quantitative coronary angiography (% diameter stenosis: 23.2 ± 12.3%), and epicardial disease was milder in women (fractional flow reserve: 0.88 ± 0.04 vs. 0.87 ± 0.04; p = 0.04). IMR was similar between the sexes (20.7 ± 9.8 vs. 19.1 ± 8.0; p = 0.45), but CFR was lower in women (3.8 ± 1.6 vs. 4.8 ± 1.9; p = 0.004). This was primarily due to a shorter resting T_mn in women (p = 0.005), suggesting increased resting coronary flow, whereas hyperemic T_mn was identical (p = 0.79). In multivariable analysis, female sex was an independent predictor of lower CFR and shorter resting T_mn.

Conclusions

Despite similar microvascular function in women and men by IMR, CFR is lower in women. This discrepancy appears to be due to differences in resting coronary flow between the sexes. The effect of sex differences should be considered in interpretation of physiological indexes using resting coronary flow.