Thromb Haemost 2019; 119(09): 1379-1381
DOI: 10.1055/s-0039-1695010
Invited Editorial Focus
Georg Thieme Verlag KG Stuttgart · New York

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

Baris Gencer
1   Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
2   TIMI Study Group, Brigham and Women's Hospitals, Harvard Medical School, Boston, Massachusetts, United States
,
François Mach
1   Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

17 July 2019

17 July 2019

Publication Date:
01 September 2019 (online)

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 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography and 99Tc-tetrofosmin SPECT-MPI, a significant increase in 18F-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.

 
  • References

  • 1 Fiechter M, Haider A, Bengs S. Sex differences in the association between inflammation and ischemic heart disease. Thromb Haemost 2019; 119 (09) 1471-1480
  • 2 Spronk HMH, Padro T, Siland JE. , et al. Atherothrombosis and thromboembolism: position paper from the Second Maastricht Consensus Conference on Thrombosis. Thromb Haemost 2018; 118 (02) 229-250
  • 3 Mehta LS, Beckie TM, DeVon HA. , et al; American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation 2016; 133 (09) 916-947
  • 4 Kurmann RD, Mankad R. Atherosclerotic heart disease in women with autoimmune rheumatologic inflammatory conditions. Can J Cardiol 2018; 34 (04) 381-389
  • 5 Jiménez MC, Rexrode KM, Kotler G. , et al. Association between markers of inflammation and total stroke by hypertensive status among women. Am J Hypertens 2016; 29 (09) 1117-1124
  • 6 Raeisi-Giglou P, Volgman AS, Patel H, Campbell S, Villablanca A, Hsich E. Advances in cardiovascular health in women over the past decade: guideline recommendations for practice. J Womens Health (Larchmt) 2018; 27 (02) 128-139
  • 7 Piepoli MF, Hoes AW, Agewall S. , et al; ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37 (29) 2315-2381
  • 8 Kuller LH, Matthews KA, Edmundowicz D, Chang Y. Incident coronary artery calcium among postmenopausal women. Atherosclerosis 2008; 200 (02) 278-285
  • 9 Iversen B, Jacobsen BK, Løchen ML. Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study. Eur J Epidemiol 2013; 28 (08) 659-667
  • 10 Lee IM, Sesso HD, Ridker PM, Mouton CP, Stefanick ML, Manson JE. Physical activity and inflammation in a multiethnic cohort of women. Med Sci Sports Exerc 2012; 44 (06) 1088-1096
  • 11 Chambless LE, Heiss G, Folsom AR. , et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol 1997; 146 (06) 483-494
  • 12 Nugent L, Mehta PK, Bairey Merz CN. Gender and microvascular angina. J Thromb Thrombolysis 2011; 31 (01) 37-46
  • 13 Gulati M, Cooper-DeHoff RM, McClure C. , et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med 2009; 169 (09) 843-850
  • 14 Mieres JH, Gulati M, Bairey Merz N. , et al; American Heart Association Cardiac Imaging Committee of the Council on Clinical Cardiology; Cardiovascular Imaging and Intervention Committee of the Council on Cardiovascular Radiology and Intervention. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130 (04) 350-379
  • 15 Pilote L, Karp I. GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: From bench to beyond-Premature Acute Coronary SYndrome). Am Heart J 2012; 163 (05) 741-746
  • 16 Ibanez B, James S, Agewall S. , et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39 (02) 119-177
  • 17 Diercks DB, Owen KP, Kontos MC. , et al. Gender differences in time to presentation for myocardial infarction before and after a national women's cardiovascular awareness campaign: a temporal analysis from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION Registry-GWTG). Am Heart J 2010; 160 (01) 80-87.e3
  • 18 Khan NA, Daskalopoulou SS, Karp I. , et al; GENESIS PRAXY Team. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med 2013; 173 (20) 1863-1871
  • 19 Pelletier R, Khan NA, Cox J. , et al; GENESIS-PRAXY Investigators. Sex versus gender-related characteristics: which predicts outcome after acute coronary syndrome in the young?. J Am Coll Cardiol 2016; 67 (02) 127-135
  • 20 Lu Y, Zhou S, Dreyer RP. , et al. Sex differences in inflammatory markers and health status among young adults with acute myocardial infarction: results from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) study. Circ Cardiovasc Qual Outcomes 2017; 10 (02) e003470
  • 21 Gencer B, Rigamonti F, Nanchen D. , et al. Prognostic value of elevated lipoprotein(a) in patients with acute coronary syndromes. Eur J Clin Invest 2019; 49 (07) e13117
  • 22 O'Donoghue ML, Fazio S, Giugliano RP. , et al. Lipoprotein(a), PCSK9 inhibition, and cardiovascular risk. Circulation 2019; 139 (12) 1483-1492
  • 23 Gencer B, Girardin F. Coronary artery disease is associated with persistent lower quality of life in women. Open Heart 2015; 2 (01) e000305
  • 24 Cove CL, Albert CM, Andreotti F, Badimon L, Van Gelder IC, Hylek EM. Female sex as an independent risk factor for stroke in atrial fibrillation: possible mechanisms. Thromb Haemost 2014; 111 (03) 385-391
  • 25 Linde C, Bongiorni MG, Birgersdotter-Green U. , et al; ESC Scientific Document Group. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace 2018; 20 (10) 1565-ao
  • 26 Weber C, Badimon L, Mach F, van der Vorst EPC. Therapeutic strategies for atherosclerosis and atherothrombosis: past, present and future. Thromb Haemost 2017; 117 (07) 1258-1264