Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease
Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease
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DOI：
10.1016/j.jcin.2015.03.045
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发表时间：
2015-09-01
影响因子：
11.3
通讯作者：
Tremmel, Jennifer A.
中科院分区：
文献类型：
--
作者：
Kobayashi, Yuhei;Fearon, William F.;Tremmel, Jennifer A.
目的探讨无梗阻性冠状动脉病变的心绞痛患者冠状动脉血流储备(CFR)和微循环阻力指数(IMR)的性别差异。背景冠状动脉微血管功能障碍与不良的远期预后相关，尤其是在女性。冠状动脉血流储备(CFR)和微循环阻力指数(IMR)是评价冠状动脉微循环的两种方法。我们对左前降支进行了CFR、IMR、血流储备分数和定量冠状动脉造影术。结果所有患者冠状动脉造影均显示轻度动脉粥样硬化(直径狭窄率：23.2+/-12.3%)，且女性心外膜病变较轻(血流储备分数：0.88+/-0.04比0.87+/-0.04；p=0.04)。性别间IMR相似(20.7±9.8vs.19.1±-8.0；p=0.45)，但女性CFR较低(3.8±1.6vs.4.8+/-1.9；p=0.004)。这主要是由于女性静息时TmN较短(p=0.005)，提示静息冠脉流量增加，而充血T-mN相同(p=0.79)。在多变量分析中，女性性别是降低CFR和缩短静息T-mn的独立预测因素。结论尽管IMR显示女性和男性的微血管功能相似，但女性的CFR较低。这种差异似乎是由于性别之间静息冠脉血流的差异。在用静息冠脉流量解释生理指标时应考虑性别差异的影响。(C)2015年，由美国心脏病学会基金会提供。
OBJECTIVES 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 Tmn 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. (C) 2015 by the American College of Cardiology Foundation.