Geschlechts spezifische Unterschiede in der absoluten myokardialen Perfusion

Summary

Aim: To investigate sex differences in myocardial perfusion especially in healthy individuals since former studies are rare and findings are controversial. Participants, methods: 26 subjects were enrolled: 16 healthy women (age: 34 ±7 years) were compared with 10 healthy men (age: 34 ± 3 years; p = ns). Myocardial blood flow (MBF) and coronary vascular resistance (CVR) were quantified at rest, during adenosine infusion and cold-pressor-testing, using positron emission tomography and radioactive-labelled water (H₂ ¹⁵O-PET). Results: Women showed higher MBF than men at rest (1.10 ± 0.18 vs. 0.85 ± 0.20 ml/min/ml; p = 0.003) and cold-stress (1.39 ± 0.38 vs. 1.06 ± 0.28 ml/min/ml; p = 0.026). Corrected for rate-pressure-product, baseline findings maintained significance (1.41 ± 0.33 vs. 1.16 ± 0.19 ml/min/ml; p = 0.024). CVR was lower in women at baseline (81 ± 14 vs. 107 ± 22 mmHg*ml^-1*min*ml; p = 0.006) and during cold-pressor-testing (71 ± 17 vs. 91 ± 20 mmHg*ml^-1*min*ml; p = 0.013). Under adenosine neither maximal MBF (4.06 ± 1.0 vs. 3.91 ± 0.88 ml/min/ml; p = ns) nor coronary flow reserve (3.07 ± 1.12 vs. 3.44 ± 0.92; p = ns) nor CVR (24 ± 8 vs. 24 ± 6 mmHg*ml^-1*min*ml; p = ns) showed sex-related differences. Conclusion: Women show higher myocardial perfusion and lower coronary vascular resistance than men in physiologic states. Maximum perfusion and vasodilation under adenosine are not sex-specific.

Zusammenfassung

Ziel: Diese Studie untersucht geschlechtsspezifische myokardiale Perfusionsunterschiede insbesondere bei jungen Erwachsenen, da ein erheblicher Mangel an belastbaren Daten besteht. Teilnehmer, Methode: 26 Teilnehmer wurden in unsere Studie eingeschlossen: 16 gesunde Frauen (34 ± 7 Jahre) wurden mit 10 gesunden Männern verglichen (34 ± 3 Jahre; p = ns). Myokardialer Blutfluss (MBF) und koronarvaskulärer Widerstand (coronary vascular resistance – CVR) wurden quantifiziert unter Ruhebedingungen, während Adenosin-Infusion und unter Kältestress mit Hilfe einer Positronenemissionstomographie und radioaktiv markiertem Wasser (H₂ ¹⁵O-PET). Ergebnisse: Frauen wiesen gegenüber Männern einen höheren MBF in Ruhe (1,10 ± 0,18 vs. 0,85 ± 0,20 ml/min/ml; p = 0,003) und unter Kälte stress auf (1,39 ± 0,38 vs. 1,06 ± 0,28 ml/min/ml; p = 0,026). Nach Korrektur des Rate-Pressure-Produkts blieb die Ruheperfusion geschlechtsspezifisch (1,41 ± 0,33 vs. 1,16 ± 0,19 ml/min/ml; p = 0,024). Der Koronar widerstand zeigte sich entsprechend niedriger in der Frauengruppe in Ruhe (81 ± 14 vs. 107 ± 22 mmHg*ml^-1 *min*ml; p = 0,006) und unter Kältestress (71 ± 17 vs. 91 ± 20 mmHg*ml^-1*min*ml; p = 0,013). Unter maximaler Hyperämie durch Adenosin zeigten weder der maximale Blutfluss im Myokard (4,06 ± 1,0 vs. 3,91 ± 0,88 ml/min/ml; p = ns) noch die Flussreserve (3,07 ± 1,12 vs. 3,44 ± 0,92; p = ns) noch der Koronarwiderstand (24 ± 8 vs. 24 ± 6 mmHg*ml^-1*min*ml; p = ns) geschlechtsspezifische Unterschiede. Schlussfolgerung: Frauen haben unter physiologischen Flussbedingungen eine höhere myokardiale Perfusion bei geringerem Koronarwiderstand als Männer. Die maximale Perfusion und Vaso dilatation unter Adenosin sind nicht geschlechtsspezifisch.

Keywords

Sex differences - myocardial blood flow - adenosine-induced hyperaemia - endothelium-dependent flow reserve - positron emission tomography

Schlüsselwörter

Geschlechtsunterschiede - myokardialer Blutfluss; Adenosin-induzierte Hyperämie - Endothel-abhängige Flussreserve - Positronenemissionstomographie

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