Key result
Resting amygdalar metabolic activity was significantly higher in women with abnormal myocardial perfusion imaging compared to those without (SUV 33.4 vs 30.4, P=0.043), a difference not seen in men.
Why the study?
Traditional risk algorithms perform worse in women than in men, and sex-specific associations between amygdalar metabolic activity and cardiac dysfunction in suspected or known CAD were unknown.
Does female sex modify the association between resting amygdalar metabolic activity and abnormal cardiac function or perfusion in patients evaluated for CAD?
Cohort (n=302)
Does female sex modify the association between resting amygdalar metabolic activity and abnormal cardiac function or perfusion in patients evaluated for CAD?
Resting amygdalar metabolic activity is associated with abnormal cardiac function and perfusion in women but not men, suggesting a sex-specific link between emotional stress and cardiovascular disease.
Answers are grounded in this paper and cite their sources.
May signal sex-specific stress-cardiac links in women; hypothesis-generating and should not yet change practice.
AIMS: Cardiovascular outcomes of women with coronary artery disease (CAD) are perceived as relatively worse when compared to men. Amygdalar metabolic activity has recently been shown to independently predict cardiovascular events in patients without known cardiovascular disease. Given that traditional algorithms for risk prediction perform worse in women than in men, we sought to assess sex-specific associations between amygdalar metabolic activity and cardiac dysfunction with suspected or known CAD. METHODS AND RESULTS: This retrospective study included 302 patients (mean age 66.8 ± 10.2 years, 29.1% women) selected for evaluation of CAD, malignant, or inflammatory disease. All patients had undergone both, myocardial perfusion imaging by single photon emission computed tomography (MPI-SPECT) and whole-body fluoro-18-deoxyglucose (18F-FDG) positron emission tomography (PET), within 6 months. 18F-FDG resting amygdalar uptake was significantly increased in women with abnormal MPI scans (standardized uptake value 33.4 ± 6.5 vs. 30.4 ± 4.7, P = 0.043), while no such difference was observed in men (P = 0.808). In women, but not in men, a negative association between 18F-FDG resting amygdalar activity and left ventricular ejection fraction (LVEF) was observed (Pearson r = -0.308, P = 0.004). Accordingly, either LVEF [B-coefficient (standard error, SE) = -0.232 (0.109), P = 0.045] or abnormal MPI [B-coefficient (SE) = 8.264 (2.449), P = 0.003] were selected as significant predictors of high amygdalar 18F-FDG uptake in a fully adjusted linear regression model in women, and a first order interaction term consisting of sex and LVEF or sex and abnormal MPI was significant (P = 0.035 and P = 0.001, respectively). CONCLUSION: Resting amygdalar metabolic activity is associated with abnormal cardiac function and perfusion in women, suggesting a link between emotional stress and cardiovascular disease in women.
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Fiechter et al. (2019) conducted a cohort in Suspected or known coronary artery disease (n=302). Abnormal myocardial perfusion imaging (MPI) vs. Normal myocardial perfusion imaging was evaluated on 18F-FDG resting amygdalar uptake (standardized uptake value) in women (p=0.043). Resting amygdalar metabolic activity was significantly higher in women with abnormal myocardial perfusion imaging compared to those without (SUV 33.4 vs 30.4, P=0.043), a difference not seen in men.
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