Gender Specificity and Interpretation of Functional Cardiac Imaging: Let's Talk about Sex

Introduction In their present study, Fiechter et al report from nuclear medicine that for women, a strong association exists between inflammation, as measured by vertebral bone marrow metabolism, and impaired myocardial function and perfusion, as assessed by single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI).[ 1 ] Among a total of 294 patients (28.6% women, mean age 67 years old) who underwent 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography and 99 Tc-tetrofosmin SPECT-MPI, a significant increase in 18 F-FDG bone marrow uptake was observed in women with impaired myocardial perfusion as compared with normal myocardial perfusion (standardized uptake 2.2 ± 1.2 vs. 1.7 ± 1.2, p = 0.013), while no differences were found in men (1.6 ± 0.8 vs. 1.6 ± 0.4, p = 0.372). In addition, a significant inverse correlation between left ventricular ejection fraction and bone marrow metabolism was seen in women ( r = –0.229, p = 0.037), but not in men ( r = –0.075, p = 0.289). The present findings are relevant, interesting, and novel as no previous study has applied two different nuclear medicine imaging modalities simultaneously to investigate the degree of inflammation and the amount of myocardial ischemia perfusion in the same patient. In particular, a major difference between genders was found, suggesting the importance of the gender specificity when interpreting cardiac functional test.