冠状动脉大血管和微血管疾病病理生理学及影像学中的性别特异性方面
Sex-Specific Aspects in the Pathophysiology and Imaging of Coronary Macro- and Microvascular Disease.
作者信息
Groepenhoff Floor, Bots Sophie H, Kessler Elise L, Sickinghe Ariane A, Eikendal Anouk L M, Leiner Tim, den Ruijter Hester M
机构信息
Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
出版信息
J Cardiovasc Transl Res. 2020 Feb;13(1):39-46. doi: 10.1007/s12265-019-09906-0. Epub 2019 Aug 30.
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.
摘要
冠状动脉疾病（CAD）中的性别差异已得到充分证实，女性比男性更常表现为非阻塞性CAD。然而，最近的证据表明冠状动脉微血管功能障碍是心脏不适的潜在原因，但特定性别的患病率数据尚无定论。本综述总结了大血管和微血管功能障碍病理生理学中已知的性别特异性方面，并确定了目前存在的知识空白。此外，本综述描述了当前的诊断方法，以及这些方法是否应考虑潜在的性别差异，例如，对女性和男性使用不同的技术或临界值。需要对成像技术的创新和灌注相关的性别差异进行未来研究，以填补证据空白，并使现有知识能够在日常临床实践中得到应用。
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2
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J Am Coll Cardiol. 2018 Nov 27;72(21):2625-2641. doi: 10.1016/j.jacc.2018.09.042.
3
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