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Thromb Haemost 2019; 119(09): 1471-1480
DOI: 10.1055/s-0039-1692442
Blood Cells, Inflammation and Infection
Georg Thieme Verlag KG Stuttgart · New York

Sex Differences in the Association between Inflammation and Ischemic Heart Disease

Michael Fiechter 
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
3   Swiss Paraplegic Center, Nottwil, Switzerland
,
Ahmed Haider
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
,
Susan Bengs
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
,
Monika Marȩdziak
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
,
Irene A. Burger
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Andrea Roggo
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Angela Portmann
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
,
Geoffrey I. Warnock
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
,
Katharina Schade
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Valerie Treyer
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Anton S. Becker
4   Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
,
Michael Messerli
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Elia von Felten
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Dominik C. Benz
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Tobias A. Fuchs
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Christoph Gräni
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Aju P. Pazhenkottil
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Ronny R. Buechel
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Philipp A. Kaufmann
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
,
Catherine Gebhard
1   Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
2   Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
› Author Affiliations Funding C.G. was supported by grants from the Swiss National Science Foundation (SNSF), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swissheart Foundation, and the Helmut Horten Foundation, Switzerland. M.F. was supported by the Swiss Paraplegic Center, Nottwil, Switzerland. M.M. was supported by the Iten-Kohaut Foundation, Switzerland.
Further Information

Publication History

20 February 2019

01 May 2019

Publication Date:
21 June 2019 (online)

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Abstract

Background Inflammation plays a fundamental role in mediating all stages of atherosclerosis. Given the higher prevalence of inflammatory rheumatologic conditions in women and the female propensity towards worse cardiovascular outcomes, refined strategies are needed to better identify the high-risk female cardiovascular phenotype.

Objectives This article aims to assess sex-specific links between inflammatory processes and the development and progression of ischemic heart disease.

Patients and Methods The relationship between vertebral bone marrow metabolism—a marker of inflammation—and myocardial injury was retrospectively assessed in 294 patients (28.6% women, mean age: 66.9 ± 10.0 years) who underwent 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 99mTc-tetrofosmin single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI).

Results A significant increase in 18F-FDG bone marrow uptake was observed in women with impaired myocardial perfusion (SPECT-MPI) as compared to women with normal myocardial perfusion (standardized uptake value [SUV]: 2.2 ± 1.2 vs. 1.7 ± 0.5, p = 0.013), while no such difference was observed in men (SUV: 1.6 ± 0.8 vs. 1.6 ± 0.4, p = 0.372). Furthermore, a significant inverse correlation between left ventricular ejection fraction (LVEF) and bone marrow metabolism was seen in women (r = –0.229, p = 0.037), but not in men (r = –0.075, p = 0.289). Accordingly, in women, but not in men, bone marrow activity was identified as an independent predictor of both, reduced LVEF (β-coefficient, –4.537; p = 0.040) and impaired myocardial perfusion (β-coefficient, 0.138; p = 0.014).

Conclusion A strong link between bone marrow metabolism and impaired myocardial function and perfusion was observed in women, but not in men. Our data suggest that novel biomarkers of inflammation might help to identify women at risk for ischemic cardiomyopathy and to tailor disease management to the female cardiovascular phenotype.

Keywords

bone marrow activity - PET/CT - inflammation - myocardial perfusion imaging - sex
 

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