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. 2019 Apr 25;1(1):e180007.
doi: 10.1148/ryct.2019180007.

Sexual Dimorphism of Coronary Artery Disease in a Low- and Intermediate-Risk Asymptomatic Population: Association with Coronary Vessel Wall Thickness at MRI in Women

Ahmed M Ghanem  1 , Jatin Raj Matta  1 , Reham Elgarf  1 , Ahmed Hamimi  1 , Ranganath Muniyappa  1 , Hadjira Ishaq  1 , Colleen Hadigan  1 , Michael V McConnell  1 , Ahmed M Gharib  1 , Khaled Z Abd-Elmoniem  1
Affiliations

Sexual Dimorphism of Coronary Artery Disease in a Low- and Intermediate-Risk Asymptomatic Population: Association with Coronary Vessel Wall Thickness at MRI in Women

Ahmed M Ghanem et al. Radiol Cardiothorac Imaging. .

Abstract

Purpose: To demonstrate the association between coronary vessel wall thickness (VWT) measured at MRI and coronary artery disease (CAD) risk in asymptomatic groups at low and intermediate risk on the basis of Framingham score.

Materials and methods: A total of 131 asymptomatic adults were prospectively enrolled. All participants underwent CT angiography for scoring CAD, and coronary VWT was measured at 3.0-T MRI. Nonlinear single and multivariable regression analyses with consideration for interaction with sex were performed to investigate the association of traditional atherosclerotic risk factors and VWT with CT angiography-based CAD scores.

Results: The analysis included 62 women and 62 men with low or intermediate Framingham score of less than 20%. Age (mean age, 45.0 years ± 14.5 [standard deviation]) and body mass index were not different between the groups. Age, sex, and VWT were individually significantly associated with all CT angiography-based CAD scores (P < .05). Additionally, sex was a significant effect modifier of the associations with all CAD scores. In men, age was the only statistically significant independent risk factor of CAD; in women, VWT was the only statistically significant independent surrogate associated with increased CAD scores (P < .05).

Conclusion: In asymptomatic women, VWT MRI was the primary independent surrogate of CAD, whereas age was the strongest risk factor in men. This study suggests that VWT may be used as a CAD surrogate in women at low or intermediate risk of CAD. Further longitudinal studies are required to determine the potential implication and use of this MRI technique for the preventative management of CAD in women.© RSNA, 2019.

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Conflict of interest statement

Disclosures of Conflicts of Interest: A.M.G. disclosed no relevant relationships. J.R.M. disclosed no relevant relationships. R.E. disclosed no relevant relationships. A.H. disclosed no relevant relationships. R.M. disclosed no relevant relationships. H.I. disclosed no relevant relationships. C.H. disclosed no relevant relationships. M.V.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed employment at Verily Life Sciences; disclosed money paid to author for stock/stock options from Verily Life Sciences. Other relationships: disclosed no relevant relationships. A.M.G. disclosed no relevant relationships. K.Z.A. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed employment at the National Institutes of Health. Other relationships: disclosed no relevant relationships.

Figures

Figure 1:
Figure 1:
Binomial-logit regression models and the local marginal associations between statistically significant factors and normalized coronary artery disease scores for segment involvement score (SIS), segment stenosis score (SSS), and segment volume score (SVS) in women and men. Coronary vessel wall thickness (VWT) was the strongest surrogate of coronary artery disease scores in women, whereas age was the strongest risk factor in men. Δ = change in, Chol = cholesterol, pts = points, SysBP = systolic blood pressure.
Figure 2a:
Figure 2a:
Likelihood probability curves showing the likelihood of having (a) coronary segment involvement score (SIS) and coronary segment stenosis score (SSS) greater than 5 in women in relation to coronary vessel wall thickness (VWT) and (b) calcified plaque in the total cohort, (c) in women, and (d) in men as a function of statistically significant factors. CI = confidence interval, OR = odds ratio, ORage = odds ratio of age, ORfemale = odds ratio of women, ORVWT = odds ratio of VWT.
Figure 2b:
Figure 2b:
Likelihood probability curves showing the likelihood of having (a) coronary segment involvement score (SIS) and coronary segment stenosis score (SSS) greater than 5 in women in relation to coronary vessel wall thickness (VWT) and (b) calcified plaque in the total cohort, (c) in women, and (d) in men as a function of statistically significant factors. CI = confidence interval, OR = odds ratio, ORage = odds ratio of age, ORfemale = odds ratio of women, ORVWT = odds ratio of VWT.
Figure 2c:
Figure 2c:
Likelihood probability curves showing the likelihood of having (a) coronary segment involvement score (SIS) and coronary segment stenosis score (SSS) greater than 5 in women in relation to coronary vessel wall thickness (VWT) and (b) calcified plaque in the total cohort, (c) in women, and (d) in men as a function of statistically significant factors. CI = confidence interval, OR = odds ratio, ORage = odds ratio of age, ORfemale = odds ratio of women, ORVWT = odds ratio of VWT.
Figure 2d:
Figure 2d:
Likelihood probability curves showing the likelihood of having (a) coronary segment involvement score (SIS) and coronary segment stenosis score (SSS) greater than 5 in women in relation to coronary vessel wall thickness (VWT) and (b) calcified plaque in the total cohort, (c) in women, and (d) in men as a function of statistically significant factors. CI = confidence interval, OR = odds ratio, ORage = odds ratio of age, ORfemale = odds ratio of women, ORVWT = odds ratio of VWT.
Figure 3:
Figure 3:
Coronary vessel wall MR images and CT angiographic images (multiplanar reformatted stretch view). Images in a 46-year-old asymptomatic woman show, A, measured vessel wall thickness of 1.3 mm (black arrows) at MRI and, B, noncalcified plaque (white arrow) in the proximal left anterior descending coronary artery at CT. Images in a 44-year-old asymptomatic woman show, C, thicker coronary vessel wall (black arrows) measured at 1.7 mm on MR image and, D, more coronary artery disease (white arrows) on coronary CT angiographic image in the left anterior descending artery.
See this image and copyright information in PMC

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