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Review
. 2020 Feb;13(1):39-46.
doi: 10.1007/s12265-019-09906-0. Epub 2019 Aug 30.

Sex-Specific Aspects in the Pathophysiology and Imaging of Coronary Macro- and Microvascular Disease

Floor Groepenhoff  1 , Sophie H Bots  2 , Elise L Kessler  2 , Ariane A Sickinghe  2 , Anouk L M Eikendal  2 , Tim Leiner  3 , Hester M den Ruijter  4
Affiliations
Review

Sex-Specific Aspects in the Pathophysiology and Imaging of Coronary Macro- and Microvascular Disease

Floor Groepenhoff et al. J Cardiovasc Transl Res. 2020 Feb.

Abstract

Sex differences in coronary artery disease (CAD) are well established, with women presenting with non-obstructive CAD more often than men do. However, recent evidence has identified coronary microvascular dysfunction as the underlying cause for cardiac complaints, yet sex-specific prevalence numbers are inconclusive. This review summarises known sex-specific aspects in the pathophysiology of both macro- and microvascular dysfunction and identifies currently existing knowledge gaps. In addition, this review describes current diagnostic approaches and whether these should take underlying sex differences into account by, for example, using different techniques or cut-off values for women and men. Future research into both innovation of imaging techniques and perfusion-related sex differences is needed to fill evidence gaps and enable the implementation of the available knowledge in daily clinical practice.

Keywords: Coronary artery disease; Coronary flow reserve (CFR); Coronary imaging; Fractional flow reserve; Index of microcirculatory resistance; Microvascular disease; Microvascular dysfunction; Sex differences.

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Conflict of interest statement

The authors have no conflicts of interests to declare.

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