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

• DOI: 10.1007/s12350-018-1276-x
• Publication Date: 2018-04-23T19:50:40Z
• Authors: Catherine Gebhard; Michael Messerli; Christine Lohmann; Valerie Treyer; Susan Bengs; Dominik C. Benz; Andreas A. Gianno...; Ken Kudura; Elia von Felten; Moritz Schwyzer; Oliver Gaemperli; Christoph Gräni; Aju P. Pazhenkottil; Ronny R. Buechel; Philipp A. Kaufmann
• Keywords: Male; Adenosine; Vasodilator Agents; Myocardial Ischemia; 610 Medicine & health; Blood Pressure; 2705 Cardiology and Cardiovascular Medicine; Cardiac Autonomic Nervous Control; 03 medical and health sciences; Age; Sex Factors; 0302 clinical medicine; Myocardial perfusion single; Heart Rate; 2741 Radiology, Nuclear Medicine and Imaging; Humans; Propensity Score; Aged; Retrospective Studies; Aged, 80 and over; Tomography, Emission-Computed, Single-Photon; photon; Age Factors; Myocardial Perfusion Imaging; 10181 Clinic for Nuclear Medicine; Middle Aged; 10209 Clinic for Cardiology; Exercise Test; Sex; Female; emission computed tomography

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.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).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.