Sex differences in non-obstructive coronary artery disease

Waheed, Nida; Elias‐Smale, Suzette; Malas, Waddah; Maas, Angela H.E.M.; Sedlak, Tara; Tremmel, Jennifer A.; Mehta, Puja K.

doi:10.1093/cvr/cvaa001

Cited by 75 publications

(54 citation statements)

References 167 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High resting myocardial ow volumes could decrease CFR (in PET and TTE) or MPRI (in CMR) in women compared to men as ow parameters are determined as the ratio of stress and rest perfusion. Although sex differences in resting MBF and CFR have been observed in invasive CRT [3,17,57], only one of the included studies included assessed sex differences regarding CBF and reported no signi cant sex differences [30]. These ndings are consistent with another study comparing non-invasive CFR between men and women using PET [58].…”

Section: Sex Differencessupporting

confidence: 62%

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Groepenhoff

Klaassen

Valstar

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Coronary microvascular dysfunction (CMD) is an important underlying cause of angina pectoris. Currently, no diagnostic tool is available to directly visualize the coronary microvasculature. Invasive microvascular reactivity testing is the diagnostic standard for CMD, but several non-invasive imaging techniques are being evaluated. However, evidence on reported non-invasive parameters and cut-off values is limited. Thus, we aimed to provide an overview of reported non-invasive parameters and corresponding cut-off values for CMD.Methods: Pubmed and EMBASE databases were systematically searched for studies enrolling patients with angina pectoris without obstructed coronary arteries, investigating at least one non-invasive imaging technique to quantify CMD. Methodological quality assessment of included studies was performed using QUADAS-2.Results: Thirty-six studies were included. Nine cardiac magnetic resonance (CMR) studies reported MPRI (n = 9) and nine positron emission tomography (PET) and transthoracic echocardiography (TTE) studies reported CFR. Mean MPRI ranged from 1.47 ± 0.36 to 1.83 ± 0.50 in patients and from 1.50 ± 0.47 to 2.23 ± 0.37 in healthy controls. Reported mean CFR in PET and TTE ranged from 1.39 ± 0.31 to 2.85 ± 1.35 and 1.69 ± 0.40 to 2.40 ± 0.40 for patients, and 2.68 ± 0.83 to 4.32 ± 1.78 and 2.65 ± 0.65 to 3.31 ± 1.10 for controls, respectively.Conclusions: This systematic review summarized current evidence on reported parameters and cut-off values to diagnose CMD for various non-invasive imaging modalities. Nonetheless, standardization of methodology and reporting of outcome measures is required to provide clinically applicable reference values.

show abstract

Section: Sex Differencessupporting

confidence: 62%

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Groepenhoff

Klaassen

Valstar

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This may explain the absence of flow-limiting lesions which can only outline contrast-filled coronary lumen. These features are more frequent in women and are associated with increased risk of CV events [ 115 , 116 ]. Additionally, women have higher prevalence of MINOCA—10.5% compared to 3.4% for men [ 4 , 117 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

Coronary Microvascular Dysfunction

Vancheri¹,

Longo²,

Vancheri

et al. 2020

JCM

186

140

View full text Add to dashboard Cite

Many patients with chest pain undergoing coronary angiography do not show significant obstructive coronary lesions. A substantial proportion of these patients have abnormalities in the function and structure of coronary microcirculation due to endothelial and smooth muscle cell dysfunction. The coronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac oxygen requirements. Impairment of this mechanism, defined as coronary microvascular dysfunction (CMD), carries an increased risk of adverse cardiovascular clinical outcomes. Coronary endothelial dysfunction accounts for approximately two-thirds of clinical conditions presenting with symptoms and signs of myocardial ischemia without obstructive coronary disease, termed “ischemia with non-obstructive coronary artery disease” (INOCA) and for a small proportion of “myocardial infarction with non-obstructive coronary artery disease” (MINOCA). More frequently, the clinical presentation of INOCA is microvascular angina due to CMD, while some patients present vasospastic angina due to epicardial spasm, and mixed epicardial and microvascular forms. CMD may be associated with focal and diffuse epicardial coronary atherosclerosis, which may reinforce each other. Both INOCA and MINOCA are more common in females. Clinical classification of CMD includes the association with conditions in which atherosclerosis has limited relevance, with non-obstructive atherosclerosis, and with obstructive atherosclerosis. Several studies already exist which support the evidence that CMD is part of systemic microvascular disease involving multiple organs, such as brain and kidney. Moreover, CMD is strongly associated with the development of heart failure with preserved ejection fraction (HFpEF), diabetes, hypertensive heart disease, and also chronic inflammatory and autoimmune diseases. Since coronary microcirculation is not visible on invasive angiography or computed tomographic coronary angiography (CTCA), the diagnosis of CMD is usually based on functional assessment of microcirculation, which can be performed by both invasive and non-invasive methods, including the assessment of delayed flow of contrast during angiography, measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), evaluation of angina induced by intracoronary acetylcholine infusion, and assessment of myocardial perfusion by positron emission tomography (PET) and magnetic resonance (CMR).

show abstract

“…For instance, men more often suffer from obstructive CAD and HF with reduced ejection fraction and other atherosclerosis-driven diseases while women more often develop stable atherosclerotic disease with plaque erosion as feature, non-obstructive CAD and heart failure (HF) with preserved ejection fraction (8,9). Non-obstructive CAD and HFpEF may no longer be considered benign with multiple studies showing a poor prognosis, high prevalence in women, and hypothesize on sex and gender-dependent mechanisms (10)(11)(12)(13)(14)(15). Most striking sex differences in terms of high prevalence in either men or women are found within diseases that are far less common such as Brugada syndrome in men, and sudden coronary artery dissection and Tsako-tsubo cardiomyopathy in women (16,17).…”

Section: Women In Clinical Studies and Sex-specific Pathologiesmentioning

confidence: 99%

Sex and Gender Matters to the Heart

Ruijter

2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Sex differences in non-obstructive coronary artery disease

Cited by 75 publications

References 167 publications

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Evaluation of Non-invasive Imaging Parameters in Coronary Microvascular Disease: A Systematic Review

Coronary Microvascular Dysfunction

Sex and Gender Matters to the Heart

Contact Info

Product

Resources

About