Microvascular dysfunction and sympathetic hyperactivity in women with supra-normal left ventricular ejection fraction (snLVEF)

Marędziak, Monika; Bengs, Susan; Portmann, Angela; Haider, Ahmed; Wijnen, Winandus J; Warnock, Geoffrey; Etter, Dominik; Froehlich, Sandro; Fiechter, Michael; Meisel, Alexander; Treyer, Valérie; Fuchs, Tobias A.; Pazhenkottil, Aju P.; Buechel, Ronny R.; Kaufmann, Philipp A.; Gebhard, Cathérine

doi:10.1007/s00259-020-04892-x

Cited by 29 publications

(49 citation statements)

References 45 publications

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“…Moreover, after myocardial infarction, younger women have a higher mortality rate than men of the same age or older women during hospitalization [ 6 ]. Coronary microvascular dysfunction (CMVD) which is associated with hyperactivation of the sympathetic nervous system is more frequently observed in women than in men, which increases the event-free mortality rate in women, but not in men [ 7 , 8 , 9 ].…”

Section: Susceptibility Of Women To Cardiovascular Diseasementioning

confidence: 99%

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind–Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

2021

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Women have been reported to be more vulnerable to the development, prognosis and mortality of cardiovascular diseases, yet the understanding of the underlying mechanisms and strategies to overcome them are still relatively undeveloped. Studies show that women’s brains are more sensitive to factors affecting mental health such as depression and stress than men’s brains. In women, poor mental health increases the risk of cardiovascular disease, and conversely, cardiovascular disease increases the incidence of mental illness such as depression. In connection with mental health and cardiovascular health, the presence of gender differences in brain activation, cortisol secretion, autonomic nervous system, vascular health and inflammatory response has been observed. This connection suggests that strategies to manage women’s mental health can contribute to preventing cardiovascular disease. Mind–body interventions, such as meditation, yoga and qigong are forms of exercise that strive to actively manage both mind and body. They can provide beneficial effects on stress reduction and mental health. They are also seen as structurally and functionally changing the brain, as well as affecting cortisol secretion, blood pressure, heart rate variability, immune reactions and reducing menopausal symptoms, thus positively affecting women’s cardiovascular health. In this review, we investigate the link between mental health, brain activation, HPA axis, autonomic nervous system, blood pressure and immune system associated with cardiovascular health in women and discuss the effects of mind–body intervention in modulating these factors.

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Section: Susceptibility Of Women To Cardiovascular Diseasementioning

confidence: 99%

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind–Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

2021

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“…Patients were prospectively enrolled in our study between March 2017 and January 2021. The study population included consecutive patients who underwent ECG-gated 13 N-ammonia PET-MPI for evaluation of suspected CMD based on clinical symptoms, but not obstructive CAD (defined as C 50% luminal stenosis) confirmed by clinically indicated invasive coronary arteriography or coronary computed tomography angiography within 3 months prior to the PET study. The most common indication for testing was the evaluation of new or worsening symptoms, including typical and atypical angina, dyspnea, or a decrease in general performance.…”

Section: Study Population and Designmentioning

confidence: 99%

“…A 1-day rest-stress protocol was used for 13 Nammonia PET-MPI. All patients were asked not to drink alcohol, tea, or coffee for 24 hours before each PET scan.…”

Section: N-ammonia Pet-mpi Protocolmentioning

confidence: 99%

“…However, these approaches do not effectively account for CMD, especially in subclinical high-risk subgroups. Electrocardiography (ECG)-gated myocardial perfusion imaging (MPI) with 13 N-ammonia PET has demonstrated excellent diagnostic accuracy of CMD through evaluating myocardial blood flow (MBF) as well as myocardial flow reserve (MFR) and offers the added value of measuring hemodynamic parameters and cardiac function. 13,14 In this study, we sought to investigate the associations between CMD and patterns of body adiposity based on BMI and WC among patients with non-obstructive CAD through ECG-gated 13 Nammonia PET-MPI.…”

Section: Introductionmentioning

confidence: 99%

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Combining body mass index with waist circumference to assess coronary microvascular function in patients with non-obstructive coronary artery disease

Wang

Huangfu

et al. 2022

Journal of Nuclear Cardiology

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Background Coronary microvascular dysfunction (CMD) may precede clinically overt coronary artery disease (CAD). Overall and central obesity (CO) are major risk factors for CAD. This study sought to investigate the subclinical significance of body adiposity patterns based on the CMD risk. Methods A total of 128 patients with non-obstructive CAD were prospectively enrolled. Patients were categorized into 4 anthropometric groups: normal weight and non-CO (NWNCO, n = 41), normal weight and CO (NWCO, n = 20), excess weight and non-CO (EWNCO, n = 26), and excess weight and CO (EWCO, n = 41). Patients underwent rest/stress electrocardiography-gated 13N-ammonia positron emission tomography to measure absolute myocardial blood flow (MBF), myocardial flow reserve (MFR), hemodynamic parameters, and cardiac function. Results Resting MBF did not differ between groups (P = .36). Compared with the NWNCO group, hyperemic MBF and MFR were significantly lower in the NWCO and EWCO groups. Notably, patients with NWCO presented the lowest hyperemic MBF and MFR and the highest incidence of CMD. Waist circumference was an independent risk factor for CMD (OR 1.05, 95% CI 1.01 to 1.10, P = .02). Conclusion In patients with non-obstructive CAD, CO may be associated with an increased risk of CMD to better fit the study findings which did not assess management or monitoring of MBF and MFR.

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“…Of note, CMVD is more frequently observed in women than in men (Dean et al, 2015). Further, CMVD is associated with sympathetic hyperactivity, which in turn contributes to a reduced event-free survival in women, but not in men (Gebhard et al, 2019;Maredziak et al, 2020). In addition, elevated baseline levels of inflammatory biomarkers and a more pronounced inflammatory response to emotional stressinduced myocardial ischemia have both been observed primarily in women (Sullivan et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The Neuro-Inflammatory-Vascular Circuit: Evidence for a Sex-Dependent Interrelation?

et al. 2020

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Cardiovascular disease (CVD) is the leading cause of death worldwide with mortality rates in women currently exceeding those in men. To date, evidence is widely lacking for unique female determinants of CVD. However, strong associations with psychological stress, obesity or elevated inflammatory biomarkers with adverse cardiovascular outcomes in women have been identified in various studies. Interestingly, amygdalar metabolic activity, a central neural structure involved in emotional stress processing, has proven to be an independent predictor of major adverse cardiovascular events (MACE). Moreover, upregulated amygdalar metabolism was directly linked to myocardial injury in women, but not in men. This newly suggested sex-dependent brain-heart interrelation was further supported by the discovery that bone marrow activity, a surrogate parameter of inflammation, represents a potential bridging link between amygdalar activity and cardiovascular pathology by fueling inflammatory processes that promote atherosclerotic disease. Such malignant cascade of events might account, at least in part, for the excess female mortality seen in women with coronary artery disease and calls for sex-specific research toward pharmacologic or behavioral modulators to improve cardiovascular outcomes, particularly in women. This mini review summarizes recent advances in cardiovascular sex-specific medicine, thereby focusing on the interplay between the limbic system, autonomic regulation and inflammatory biomarkers, which may help to tailor CVD management toward the female cardiovascular phenotype.

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Microvascular dysfunction and sympathetic hyperactivity in women with supra-normal left ventricular ejection fraction (snLVEF)

Cited by 29 publications

References 45 publications

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind–Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind–Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

Combining body mass index with waist circumference to assess coronary microvascular function in patients with non-obstructive coronary artery disease

The Neuro-Inflammatory-Vascular Circuit: Evidence for a Sex-Dependent Interrelation?

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