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Microvascular dysfunction and sympathetic hyperactivity in women with supra-normal left ventricular ejection fraction (snLVEF).
Maredziak, Monika; Bengs, Susan; Portmann, Angela; Haider, Ahmed; Wijnen, Winandus J; Warnock, Geoffrey I; Etter, Dominik; Froehlich, Sandro; Fiechter, Michael; Meisel, Alexander; Treyer, Valerie; Fuchs, Tobias A; Pazhenkottil, Aju P; Buechel, Ronny R; Kaufmann, Philipp A; Gebhard, Catherine.
Afiliación
  • Maredziak M; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Bengs S; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Portmann A; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Haider A; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Wijnen WJ; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Warnock GI; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Etter D; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Froehlich S; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Fiechter M; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Meisel A; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Treyer V; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Fuchs TA; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Pazhenkottil AP; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Buechel RR; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Kaufmann PA; Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
  • Gebhard C; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
Eur J Nucl Med Mol Imaging ; 47(13): 3094-3106, 2020 12.
Article en En | MEDLINE | ID: mdl-32506162
BACKGROUND: Recently, a new disease phenotype characterized by supra-normal left ventricular ejection fraction (snLVEF) has been suggested, based on large datasets demonstrating an increased all-cause mortality in individuals with an LVEF > 65%. The underlying mechanisms of this association are currently unknown. METHODS: A total of 1367 patients (352 women, mean age 63.1 ± 11.6 years) underwent clinically indicated rest/adenosine stress ECG-gated 13N-ammonia positron emission tomography (PET) between 1995 and 2017 at our institution. All patients were categorized according to LVEF. A subcohort of 698 patients (150 women) were followed for major adverse cardiac events (MACEs), a composite of cardiac death, non-fatal myocardial infarction, cardiac-related hospitalization, and revascularization. RESULTS: The prevalence of a snLVEF (≥ 65%) was higher in women as compared to that in men (31.3% vs 18.8%, p < 0.001). In women, a significant reduction in coronary flow reserve (CFR, p < 0.001 vs normal LVEF) and a blunted heart rate reserve (% HRR, p = 0.004 vs normal LVEF) during pharmacological stress testing-a surrogate marker for autonomic dysregulation-were associated with snLVEF. Accordingly, reduced CFR and HRR were identified as strong and independent predictors for snLVEF in women in a fully adjusted multinomial regression analysis. After a median follow-up time of 5.6 years, women with snLVEF experienced more often a MACE than women with normal (55-65%) LVEF (log rank p < 0.001), while such correlation was absent in men (log rank p = 0.76). CONCLUSION: snLVEF is associated with an increased risk of MACE in women, but not in men. Microvascular dysfunction and an increased sympathetic tone in women may account for this association.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Disfunción Ventricular Izquierda / Infarto del Miocardio Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Nucl Med Mol Imaging Asunto de la revista: MEDICINA NUCLEAR Año: 2020 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Disfunción Ventricular Izquierda / Infarto del Miocardio Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Nucl Med Mol Imaging Asunto de la revista: MEDICINA NUCLEAR Año: 2020 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Alemania