Sex-Specific Aspects in the Pathophysiology and Imaging of Coronary Macro- and Microvascular Disease

Abstract

Sex differences in coronary artery disease (CAD) are well established, with women presenting with non-obstructive CAD more often than men do. However, recent evidence has identified coronary microvascular dysfunction as the underlying cause for cardiac complaints, yet sex-specific prevalence numbers are inconclusive. This review summarises known sex-specific aspects in the pathophysiology of both macro-and microvascular dysfunction and identifies currently existing knowledge gaps. In addition, this review describes current diagnostic approaches and whether these should take underlying sex differences into account by, for example, using different techniques or cut-off values for women and men. Future research into both innovation of imaging techniques and perfusion-related sex differences is needed to fill evidence gaps and enable the implementation of the available knowledge in daily clinical practice.

A Practical Approach to Invasive Testing in Ischemia With No Obstructive Coronary Arteries (INOCA)

“…The decreased NO availability also causes impaired coronary microvascular dilatation. 28 Finally, high levels of high sensitivity C-reactive protein (hs-CRP), a marker of chronic inflammation, have been found to be associated with increased frequency of ischemic episodes in patients with INOCA. 29 Systemic inflammation has been demonstrated to correlate with microvascular abnormalities, the fact that women have more inflammatory biomarkers at baseline, including hs-CRP, is well established.…”

Sex differences in contributors to coronary microvascular dysfunction

“…Within the coronary 10.3389/fcvm.2023.1085914 microvasculature, less is known. Most literature cites higher prevalence of systemic and macrovascular coronary vasomotor disorders, as well as differences neurological mediation of coronary function in women, which theoretically may lead toward CMD and subsequent coronary rarefaction contributing to HFpEF (14)(15)(16)(17). Given the high diversity of phenotypes contained within CMD, these explanations seem to provide an incomplete accounting for differences between women and men.…”

Coronary tortuosity: a new gender related risk factor?

“…Gropenhof et Al. (19) Coronary tortuosity in uences hemodynamics in many way, Vorobotsova et al using computational study investigated pressure drop, wall shear stress and helical ow steght measured by helicity intensity in idealized and in patient speci c geometries. They demostrate how tortuosity is strogly retated to helicity intensity and wall shear stress and explain how tortuosity seems to be potective against obstructive coronary disease but is a risk factor for spontaneus dissection.…”