The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Sex-Specific Differences in Coronary Blood Flow and Flow Velocity Reserve in Symptomatic Patients with Non-obstructive Disease

DOI: 10.4244/EIJ-D-19-00520

1. Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN USA
2. Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN USA
3. Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN USA
4. Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN USA; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN USA
5. Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, MN, USA, United States
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Aims: Reduced coronary flow velocity reserve (CFVR) is associated with adverse cardiovascular outcomes. Whether CFVR and coronary blood flow (CBF) are similar in men and women with chest pain and non-obstructive CAD remains unknown. We hypothesized sex-differences in CFVR and CBF. 

Methods and results: 1683 patients with signs/symptoms of ischemia and angiographically unobstructed coronary arteries (<40% angiographic stenosis) underwent coronary vasomotion evaluation. CFVR was measured as hyperemic/resting average velocity in the LAD. Mid-LAD diameter was measured with quantitative angiography and CBF calculated at rest (rCBF) and hyperemia (hCBF). Resting microvascular resistance (rMR) was calculated as mean arterial pressure/rCBF. 1096 (65%) were women, median age 51 (42, 59) years. Compared to men, women had lower median CFVR [2.7 (2.4, 3.2) vs. 3.1 (2.7, 3.6), p<0.001], higher rCBF [49.7 (34.0, 71.1) vs. 45.9 (31.8, 68.7) ml/min, p=0.04], lower hCBF [139.5 (93.0, 195.2) vs. 147.1 (95.7, 218.6) ml/min, p=0.02], but similar rMR (p=0.82). Female sex was independent predictor of lower CFVR, higher rCBF, and lower hCBF. 

Conclusions: Compared to men, women with signs/symptoms of ischemia and non-obstructive CAD have lower CFVR, higher rCBF, and lower hCBF.  Female sex is predictor of these sex-specific differences. The clinical diagnostic and prognostic implications of sex-differences in coronary physiology need further evaluation.

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