Introduction
Methods
Patient population
Men (n = 50) | Women (n = 78) |
p-value | |
---|---|---|---|
Age (years, mean ± SD) | 52 ± 10 | 55 ± 10 | 0.18 |
Risk factors for CAD | |||
BMI (kg·m−2, mean ± SD) | 27 ± 4 | 27 ± 4 | 0.52 |
Diabetes mellitus, n (%) | 11 (22) | 10 (13) | 0.17 |
Hypertension, n (%) | 18 (36) | 33 (42) | 0.48 |
Hypercholesterolaemia, n (%) | 12 (24) | 25 (32) | 0.33 |
Family history of premature CAD, n (%) | 21 (42) | 39 (50) | 0.38 |
History of smoking, n (%) | 19 (38) | 33 (42) | 0.63 |
Medication, n (%) | |||
Statins | 24 (48) | 39 (50) | 0.83 |
Beta-blockers | 26 (52) | 48 (62) | 0.29 |
Aspirin | 28 (56) | 46 (59) | 0.74 |
ACE inhibitors | 5 (10) | 13 (17) | 0.21 |
AT-II antagonists | 4 (8) | 14 (18) | 0.09 |
Calcium antagonists | 9 (18) | 15 (19) | 0.86 |
Long-acting nitrates | 7 (14) | 8 (10) | 0.52 |
Reason for referral, n (%) | |||
Typical angina pectoris | 7 (14) | 18 (23) | 0.21 |
Atypical angina pectoris | 19 (38) | 37 (47) | 0.29 |
Non-anginal chest pain | 16 (32) | 17 (22) | 0.20 |
High risk, no chest discomfort | 8 (16) | 6 (8) | 0.14 |
Pretest likelihood of CAD, n (%) | |||
Low | 10 (20) | 25 (32) | 0.14 |
Intermediate | 35 (70) | 45 (58) | 0.16 |
High | 5 (10) | 8 (10) | 0.96 |
PET imaging
CT imaging
Invasive coronary angiography
Data interpretation
Statistical analysis
Results
Haemodynamics
Parameter | Men (n = 50) | Women (n = 78) |
p-value | |
---|---|---|---|---|
Heart rate (bpm) | Baseline | 60 ± 8 | 62 ± 9 | 0.19 |
Hyperaemia | 79 ± 14 | 82 ± 14 | 0.27 | |
p-value (overall difference) | <0.001 | <0.001 | ||
Systolic blood pressure (mmHg) | Baseline | 109 ± 16 | 110 ± 16 | 0.65 |
Hyperaemia | 113 ± 17 | 114 ± 19 | 0.72 | |
p-value (overall difference) | 0.27 | 0.20 | ||
Diastolic blood pressure (mmHg) | Baseline | 60 ± 10 | 59 ± 7 | 0.93 |
Hyperaemia | 60 ± 7 | 59 ± 8 | 0.63 | |
p-value (overall difference) | 0.39 | 0.60 | ||
Rate–pressure product (mmHg·min−1) | Baseline | 6,523 ± 1,423 | 6,876 ± 1,551 | 0.20 |
Hyperaemia | 8,959 ± 2,184 | 9,372 ± 2,370 | 0.33 | |
p-value (overall difference) | <0.001 | <0.001 | ||
Mean arterial pressure (mmHg) | Baseline | 76 ± 11 | 76 ± 9 | 0.85 |
Hyperaemia | 76 ± 10 | 77 ± 11 | 0.66 | |
p-value (overall difference) | 0.90 | 0.64 |
Baseline MBF
Parameter | Men | Women |
p-value |
---|---|---|---|
Globala
| 0.91 ± 0.34 (0.54–2.35) | 1.09 ± 0.30 (0.59–2.75) | <0.01 |
Vascular territory | |||
Left circumflex artery | 0.91 ± 0.36 (0.54–2.38) | 1.12 ± 0.30 (0.55–2.70) | <0.01 |
Right coronary artery | 0.86 ± 0.32 (0.40–2.33) | 1.03 ± 0.28 (0.55–2.40) | <0.01 |
Left anterior descending artery | 0.97 ± 0.36 (0.57–2.34) | 1.11 ± 0.34 (0.64–3.07) | 0.02 |
p-value | 0.33 | 0.16 | |
Myocardial region | |||
Septum | 0.92 ± 0.36 (0.52–2.57) | 1.08 ± 0.33 (0.58–3.02) | 0.01 |
Inferior | 0.84 ± 0.30 (0.35–2.08) | 1.01 ± 0.27 (0.55–2.18)* | <0.01 |
Lateral | 0.92 ± 0.36 (0.54–2.38) | 1.12 ± 0.30 (0.55–2.70) | <0.01 |
Anterior | 1.03 ± 0.39 (0.56–2.45) | 1.18 ± 0.36 (0.71–3.19) | 0.03 |
p-value | 0.07 | 0.01 |
Hyperaemic MBF
Parameter | Men | Women |
p-value |
---|---|---|---|
Globala
| 2.90 ± 0.85 (1.52–5.22) | 3.78 ± 1.27 (1.72–8.15) | <0.001 |
Vascular territory | |||
Left circumflex artery | 2.99 ± 0.99 (1.63–6.62) | 3.84 ± 1.23 (1.74–7.89) | <0.001 |
Right coronary artery | 2.83 ± 0.84 (1.43–5.41) | 3.67 ± 1.34 (1.83–8.85) | <0.001 |
Left anterior descending artery | 2.92 ± 0.86 (1.51–5.49) | 3.85 ± 1.35 (1.60–8.38) | <0.001 |
p-value | 0.67 | 0.61 | |
Myocardial region | |||
Septum | 2.78 ± 0.78 (1.33–4.70) | 3.76 ± 1.40 (1.71–8.67) | <0.001 |
Inferior | 2.95 ± 1.05 (1.39–7.00) | 3.70 ± 1.30 (1.77–8.05) | <0.01 |
Lateral | 2.99 ± 1.00 (1.59–6.62) | 3.84 ± 1.23 (1.74–7.89) | <0.001 |
Anterior | 2.98 ± 0.98 (1.38–6.31) | 3.92 ± 1.58 (1.65–9.51) | <0.001 |
p-value | 0.51 | 0.78 |
Coronary flow reserve
Parameter | Men | Women |
p-value |
---|---|---|---|
Globala
| 3.42 ± 1.24 (1.55–7.97) | 3.67 ± 1.45 (1.36–9.06) | 0.33 |
Vascular territory | |||
Left circumflex artery | 3.52 ± 1.42 (1.64–9.88) | 3.64 ± 1.46 (1.36–9.38) | 0.66 |
Right coronary artery | 3.56 ± 1.39 (1.44–8.93) | 3.77 ± 1.66 (1.44–10.00) | 0.46 |
Left anterior descending artery | 3.25 ± 1.21 (1.48–7.37) | 3.66 ± 1.46 (1.26–9.36) | 0.10 |
p-value | 0.45 | 0.86 | |
Myocardial region | |||
Septum | 3.27 ± 1.17 (1.19–6.97) | 3.68 ± 1.50 (1.15–8.84) | 0.10 |
Inferior | 3.77 ± 1.54 (1.52–10.41) | 3.91 ± 1.80 (1.62–10.33) | 0.64 |
Lateral | 3.51 ± 1.44 (1.63–9.87) | 3.64 ± 1.46 (1.36–9.47) | 0.61 |
Anterior | 3.12 ± 1.28 (1.23–7.36) | 3.49 ± 1.48 (1.21–9.00) | 0.15 |
p-value | 0.09 | 0.40 |
Impact of CAD risk factors on myocardial perfusion and flow reserve
Factor |
n
| MBF (ml·min−1·g−1) | CFR | |
---|---|---|---|---|
Baseline | Hyperaemic | |||
Age (years) | ||||
31–49 | 41 | 1.06 ± 0.39 | 3.72 ± 1.46 | 3.75 ± 1.53 |
50–57 | 45 | 1.00 ± 0.34 | 3.63 ± 1.10 | 3.88 ± 1.45 |
58–83 | 42 | 0.99 ± 0.24 | 2.95 ± 0.84* | 3.07 ± 0.93 |
p-value (overall difference) | 0.58 | <0.01 | 0.01 | |
Gender | ||||
Men | 50 | 0.91 ± 0.34 | 2.90 ± 0.85 | 3.42 ± 1.24 |
Women | 78 | 1.09 ± 0.30 | 3.78 ± 1.27 | 3.67 ± 1.45 |
p-value (t test) | <0.01 | <0.001 | 0.33 | |
Hypertension | ||||
Yes | 51 | 1.04 ± 0.34 | 3.31 ± 1.23 | 3.38 ± 1.46 |
No | 77 | 1.00 ± 0.32 | 3.52 ± 1.18 | 3.70 ± 1.30 |
p-value (t test) | 0.15 | 0.30 | 0.09 | |
Diabetes | ||||
Yes | 21 | 1.03 ± 0.45 | 2.70 ± 0.61 | 2.80 ± 0.72 |
No | 107 | 1.02 ± 0.30 | 3.58 ± 1.23 | 3.73 ± 1.42 |
p-value (t test) | 0.67 | <0.01 | <0.01 | |
History of smoking | ||||
Yes | 52 | 0.99 ± 0.21 | 3.50 ± 1.14 | 3.68 ± 1.40 |
No | 76 | 1.04 ± 0.38 | 3.39 ± 1.24 | 3.50 ± 1.35 |
p-value (t test) | 0.84 | 0.47 | 0.54 | |
Hypercholesterolaemia | ||||
Yes | 37 | 1.01 ± 0.37 | 3.17 ± 1.26 | 3.33 ± 1.32 |
No | 91 | 1.03 ± 0.31 | 3.55 ± 1.16 | 3.67 ± 1.39 |
p-value (t test) | 0.78 | 0.03 | 0.10 | |
Family history | ||||
Yes | 60 | 1.05 ± 0.35 | 3.55 ± 1.03 | 3.67 ± 1.45 |
No | 68 | 1.00 ± 0.31 | 3.34 ± 1.33 | 3.49 ± 1.30 |
p-value (t test) | 0.52 | 0.13 | 0.51 | |
BMI (kg·m−2) | ||||
<25 | 43 | 1.06 ± 0.35 | 3.87 ± 1.29 | 3.86 ± 1.40 |
25–28 | 42 | 1.01 ± 0.38 | 3.37 ± 1.12 | 3.55 ± 1.19 |
>28 | 43 | 0.97 ± 0.24 | 3.07 ± 1.05** | 3.32 ± 1.47 |
p-value (overall difference) | 0.50 | <0.01 | 0.19 |
Variable | Hyperaemic MBF | CFR | ||||||
---|---|---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | |||||
β
|
p-value |
β
|
p-value |
β
|
p-value |
β
|
p-value | |
Age | −0.03 | <0.01 | −0.04 | <0.001 | −0.03 | <0.01 | −0.03 | 0.02 |
Gender (male) | −0.88 | <0.001 | −0.94 | <0.001 | −0.25 | 0.33 | – | – |
BMI | −0.08 | <0.01 | −0.07 | <0.01 | −0.06 | 0.03 | – | – |
Diabetes mellitus type II | −0.88 | <0.01 | – | – | −0.92 | <0.01 | −0.80 | 0.01 |
Hypertension | −0.22 | 0.32 | – | – | −0.32 | 0.20 | – | – |
Hypercholesterolaemia | −0.38 | 0.10 | – | – | −0.34 | 0.21 | – | – |
Smoking history | 0.11 | 0.61 | – | – | 0.18 | 0.47 | – | – |
Family history of CAD | 0.20 | 0.34 | – | – | 0.18 | 0.47 | – | – |