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Sex and age differences in the association of heart rate responses to adenosine and myocardial ischemia in patients undergoing myocardial perfusion imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

In light of growing cardiovascular mortality rates observed in young women, sexual dimorphism in cardiac autonomic nervous control is gaining increasing attention. Heart rate responses to adenosine mirror autonomic activity and may carry important prognostic information.

Methods and Results

Hemodynamic changes during adenosine stress were retrospectively analysed in a propensity-matched cohort of 1932 consecutive patients undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT). Heart rate (HR) and systolic blood pressure (SBP) increased during adenosine infusion (P < 0.001). The increase in SBP and HR (heart rate reserve, HRR), was significantly more pronounced in women compared with men (P < 0.05). Patients ≤ 55 years had a higher HRR compared with patients > 55 years (46.8% vs 37.5%, P = 0.015). Women ≤ 55 years with a reversible perfusion defect on MPI-SPECT exhibited the highest HRR (89.2%), while age-matched men showed a blunted HR response to adenosine (26.4%, P = 0.01). Accordingly, age and an interaction term of female sex and increased HRR were identified as significant predictors of myocardial ischemia in a multiple regression analysis (OR 1.4, 95% CI 1.02-1.9, P = 0.038).

Conclusion

HRR during adenosine infusion is influenced by age and sex. Our data suggest a stronger, sympathetic-driven, hemodynamic response to adenosine in younger women with myocardial ischemia.

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Abbreviations

BMI:

Body mass index

CAD:

Coronary artery disease

CACS:

Coronary artery calcium scoring

CFR:

Coronary flow reserve

CT:

Computed tomography

HRR:

Heart rate reserve

LVEF:

Left ventricular ejection fraction

MAP:

Mean arterial pressure

MCD:

Microvascular coronary dysfunction

MPI-SPECT:

Myocardial perfusion single-photon-emission computed tomography

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Disclosures

All authors have the following to disclose: The University Hospital of Zurich holds a research contract with GE Healthcare.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland

    Catherine Gebhard MD, PhD, Michael Messerli MD, Christine Lohmann MSc, Valerie Treyer PhD, Susan Bengs PhD, Dominik C. Benz MD, Andreas A. Giannopoulos MD, PhD, Ken Kudura MD, Elia von Felten MD, Moritz Schwyzer MD, Oliver Gaemperli MD, Christoph Gräni MD, PhD, Aju P. Pazhenkottil MD, Ronny R. Buechel MD & Philipp A. Kaufmann MD

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  1. Catherine Gebhard MD, PhD
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Correspondence to Catherine Gebhard MD, PhD.

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Funding This work was supported by Grants from the Swiss National Science Foundation (SNSF), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, and the Swissheart Foundation.

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Gebhard, C., Messerli, M., Lohmann, C. et al. Sex and age differences in the association of heart rate responses to adenosine and myocardial ischemia in patients undergoing myocardial perfusion imaging. J. Nucl. Cardiol. 27, 159–170 (2020). https://doi.org/10.1007/s12350-018-1276-x

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  • DOI: https://doi.org/10.1007/s12350-018-1276-x

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