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Nuklearmedizin 2016; 55(05): 196-202
DOI: 10.3413/Nukmed-0821-16-04
Original article
Schattauer GmbH

Geschlechts spezifische Unterschiede in der absoluten myokardialen Perfusion

Non-invasive H2 15O-PET in young healthy adultsSex differences in absolute myocardial perfusionNicht-invasive H2 15O-PET bei jungen Erwachsenen
Felix T. Range
1   Department of Nuclear Medicine, University of Münster, Germany
2   Department of Cardiovascular Medicine, University of Münster, Germany
4   Department of Cardiology, Pneumology and Angiology, University of Düsseldorf, Germany
,
Peter Kies
1   Department of Nuclear Medicine, University of Münster, Germany
,
Klaus P. Schäfers
1   Department of Nuclear Medicine, University of Münster, Germany
,
Günter Breithardt
2   Department of Cardiovascular Medicine, University of Münster, Germany
,
Otmar Schober
1   Department of Nuclear Medicine, University of Münster, Germany
,
Thomas Wichter
2   Department of Cardiovascular Medicine, University of Münster, Germany
,
Michael A. Schäfers
1   Department of Nuclear Medicine, University of Münster, Germany
3   Interdisciplinary Centre of Clinical Research (IZKF), University of Münster, Germany
› Author Affiliations
Further Information

Publication History

received: 14 April 2016

accepted in revised form: 17 June 2016

Publication Date:
20 December 2017 (online)

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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
 

  • References

  • 1 Buus NH, Bottcher M, Hermansen F. et al. Influence of nitric oxide synthase and adrenergic inhibition on adenosine-induced myocardial hyperemia. Circulation 2001; 104: 2305-2310.
    CrossrefPubMedGoogle Scholar
  • 2 Campisi R, Czernin J, Schoder H. et al. Effects of long-term smoking on myocardial blood flow, coronary vasomotion, and vasodilator capacity. Circulation 1998; 98: 119-125.
    CrossrefPubMedGoogle Scholar
  • 3 Chareonthaitawee P, Kaufmann PA, Rimoldi O, Camici PG. Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. Cardiovasc Res 2001; 50: 151-161.
    CrossrefPubMedGoogle Scholar
  • 4 Czernin J, Muller P, Chan S. et al. Influence of age and hemodynamics on myocardial blood flow and flow reserve. Circulation 1993; 88: 62-69.
    CrossrefPubMedGoogle Scholar
  • 5 Danad I, Raijmakers PG, Appleman YE. et al. Coronary risk factors and myocardial blood flow in patients evaluated for coronary artery disease: a quantitative [15O]H2O PET/CT study. Eur J Nucl Med Mol Imaging 2012; 39: 102-112.
    CrossrefPubMedGoogle Scholar
  • 6 Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Eng J Med 1979; 300: 1350-1358.
    CrossrefPubMedGoogle Scholar
  • 7 Dorbala S, Hassan A, Heinonen T. et al. RAMPART-Investigators. Coronary vasodilator reserve and Framingham risk scores in subjects at risk for coronary artery disease. J Nucl Cardiol 2006; 13: 761-767.
    CrossrefPubMedGoogle Scholar
  • 8 Duvernoy CS, Meyer C, Seifert-Klauss V. et al. Gender differences in myocardial blood flow dynamics: lipid profile and hemodynamic effects. JACC 1999; 33: 463-470.
    CrossrefPubMedGoogle Scholar
  • 9 Iida H, Yokoyama I, Agostini D. et al. Quantitative assessment of regional myocardial blood flow using oxygen-15-labelled water and positron emission tomography: a multicentre evaluation in Japan. Eur J Nucl Med Mol Imaging 2000; 27: 192-201.
    CrossrefPubMedGoogle Scholar
  • 10 Kaufmann PA, Gnecchi-Ruscone T, Yap JT. et al. Assessment of the reproducibility of baseline and hyperemic myocardial blood flow measurements with oxygen-15-labeled water and PET. J Nucl Med 1999; 40: 1848-1856.
    PubMedGoogle Scholar
  • 11 Maric C. Sex differences in cardiovascular disease and hypertension: involvement of the renin-angiotensin system. Hypertension 2005; 46: 475-476.
    CrossrefPubMedGoogle Scholar
  • 12 Prior JO, Schindler TH, Facta AD. et al. Determinants of myocardial blood flow response to cold pressor testing and pharmacologic vasodilation in healthy humans. Eur J Nucl Med Mol Imaging 2007; 34: 20-27.
    PubMedGoogle Scholar
  • 13 Range FT, Schafers M, Acil T. et al. Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation. Eur Heart J 2007; 28: 2223-2230.
    CrossrefPubMedGoogle Scholar
  • 14 Rosen SD, Uren NG, Kaski JC. et al. Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994; 90: 50-60.
    CrossrefPubMedGoogle Scholar
  • 15 Schäfers KP, Spinks TJ, Camici PG. et al. Absolute quantification of myocardial blood flow with H2 15O and 3-dimensional PET: an experimental validation. JNM 2002; 43: 1031-1040.
    Google Scholar
  • 16 Siegrist PT, Gaemperli O, Koepfli P. et al. Repeatability of cold pressor test-induced flow increase assessed with H2 15O and PET. J Nucl Med 2006; 47: 1420-1426.
    PubMedGoogle Scholar
  • 17 Uren NG, Camici PG, Melin JA. et al. Effect of aging on myocardial perfusion reserve. J Nucl Med 1995; 36: 2032-2036.
    PubMedGoogle Scholar
  • 18 Wang L, Jerosch-Herold M, Jacobs Jr DR. et al. Coronary risk factors and myocardial perfusion in asymptomatic adults: the Multi-Ethnic Study of Atherosclerosis (MESA). JACC 2006; 47: 565-572.
    CrossrefPubMedGoogle Scholar
  • 19 Wilson PW, D’Agostino RB, Levy D. et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-1847.
    CrossrefPubMedGoogle Scholar
  • 20 Wyss CA, Koepfli P, Mikolajczyk K. et al. Bicycle exercise stress in PET for assessment of coronary flow reserve: repeatability and comparison with adenosine stress. J Nucl Med 2003; 44: 146-154.
    PubMedGoogle Scholar