Key result
Female sex is linked to ~13% lower myocardial flow reserve across epicardial CAD.
Why the study?
Diabetes mellitus and female sex are associated with coronary microvascular dysfunction, but their differential impact on myocardial flow reserve across epicardial coronary disease severity is not well quantified.
Are diabetes mellitus and female sex associated with impaired myocardial flow reserve across the spectrum of epicardial coronary artery disease?
Observational (n=222)
Are diabetes mellitus and female sex associated with impaired myocardial flow reserve across the spectrum of epicardial coronary artery disease?
Effect estimate: -13% reduction for female sex
Diabetes and female sex are independently associated with accelerated impairment of myocardial flow reserve in patients with epicardial coronary artery disease.
May inform MFR interpretation by sex and diabetes status in CAD; hypothesis-generating for targeted microvascular therapies.
AIMS: Diabetes mellitus (DM) affects the macro- and microvasculature, leading to impairment in coronary vascular reactivity. Microvascular dysfunction is more prevalent in females compared to males, leading to increased cardiovascular risk in women. The purpose of this study was to quantify the association between diabetes and female sex on myocardial flow reserve (MFR) across the spectrum of epicardial coronary artery disease (CAD). METHODS AND RESULTS: In 222 patients with known or suspected CAD (63.7 ± 10.7 years, 66 females, 85 with diabetes) who had rubidium-82 positron emission tomography (PET) and invasive coronary angiography within 6 months, a multiple linear regression model was developed to predict MFR based on clinical risk factors and imaging results across a spectrum of regional epicardial disease. A significant interaction effect suggested that impairment of MFR is accelerated in diabetics with increasing severity of epicardial disease. Furthermore, female sex (-13%), decade of age (-6%), ischaemia on electrocardiogram (-10%), resting rate-pressure product (-3%), and rest end-diastolic volume (-0.2%) were associated with reductions in MFR independent of the combined extent and severity of epicardial disease. CONCLUSION: In the presence of significant obstructive epicardial disease, MFR decreases more rapidly in patients with DM compared to those without. Additional patient demographics and risk factors such as female sex and older age, and stress PET functional parameters should also be considered in the clinical interpretation of MFR. This has implications for the diagnosis and management of CAD patients with these and other risk factors for microvascular disease.
No takes yet. Share an insight, caveat, or question.
Wu et al. (2019) conducted an observational in known or suspected CAD (n=222). Diabetes mellitus and female sex vs. Patients without diabetes and male sex was evaluated on Myocardial flow reserve (MFR) (-13% reduction for female sex). Diabetes mellitus and female sex (associated with a 13% reduction) were independently associated with impaired myocardial flow reserve across the spectrum of epicardial coronary artery disease.