2025/02 - Sex differences and determinants of coronary microvascular function in asymptomatic adults with type 2 diabetes [Journal Club]-Sex differences and determinants of coronary microvascular function in asymptomatic adults with type 2 diabetes

Sex differences and determinants of coronary microvascular function in asymptomatic adults with type 2 diabetes

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Video Summary

The webinar introduced a JCMR study on sex differences in coronary microvascular function in asymptomatic adults with type 2 diabetes. The presenter explained the background: diabetes is a major global health burden and increases cardiovascular risk, especially heart failure, with evidence that women may be disproportionately affected. Using cardiac MRI quantitative perfusion, the team studied nearly 500 people with type 2 diabetes and 116 controls, assessing myocardial perfusion reserve (MPR) along with cardiac structure and function.<br /><br />Key findings were that both men and women with diabetes had lower MPR than controls, but women with diabetes had significantly lower MPR than men, with nearly double the prevalence of microvascular dysfunction. In women, the lower MPR was mainly driven by reduced stress blood flow; in men, it was driven more by higher resting blood flow. Female sex and systolic blood pressure were independent predictors of lower MPR overall, but sex-stratified analyses showed BMI was the main modifiable factor in women and systolic blood pressure in men.<br /><br />The discussion focused heavily on technical issues in CMR perfusion, including spatial resolution, contouring, input function selection, and the interpretation of quantitative versus visual perfusion. The session concluded that these findings may support sex-specific prevention strategies, but prospective trials are needed before changing clinical practice.

Keywords

type 2 diabetes

sex differences

coronary microvascular function

cardiac MRI

myocardial perfusion reserve

women's cardiovascular risk

microvascular dysfunction

systolic blood pressure

quantitative perfusion