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Impact of Age and Sex on Coronary Flow Reserve and Microvascular Function in Patients With Angina and Nonobstructive Coronary Arteries

Year: 2025

Type: article

Abstract: Background Angina and nonobstructive coronary arteries (ANOCA) is increasingly recognized, but the impact of age and sex on coronary microvascular function on this population has received limited study. Methods In 206 consecutive patients with ANOCA, invasive coronary function testing was performed including vasoreactivity testing with acetylcholine provocation, guidewire-based assessment of coronary flow reserve (CFR) with bolus thermodilution, and index of microcirculatory resistance (IMR). Multivariable regression models assessed associations of age and sex with coronary physiologic indices, and subgroup analyses were conducted to examine age-related trends in microvascular function separately in males and females. Results Mean age was 57.1 ± 11.2 years (range 27 to 81 years), and 149 (72.3%) were females. Increasing age was associated with progressive decrease in CFR (β=-0.05, p=0.001) and increase in hyperemic mean transit time (Tmn) (β=0.009; p<0.001) and IMR (β=0.63; p<0.001). Baseline Tmn was similar among the three age groups. Females had lower IMR (24.5 ± 13.5 vs. 30.2 ± 18.1; p=0.038), and shorter baseline and hyperemic Tmn, but similar CFR (3.43 ± 1.59 vs. 3.73 ± 1.94; p=0.315) compared to males. In sex-stratified analysis, age was significantly associated with higher IMR in females (β = 0.51, p<0.001), but not in males (β = 0.29, p=0.154). CFR declined significantly with increasing age in both sexes, with a stronger association in females (β = -0.04, p<0.001) than in males (β = -0.06, p=0.011). Conclusions Increasing age was associated with a decrease in coronary microvascular function and increase in microcirculatory resistance, which was pronounced in females but not in males. There was no association of baseline Tmn with age, suggesting that age-related impairment in CFR was primarily driven by reduced hyperemic flow.

Source: Journal of the Society for Cardiovascular Angiography & Interventions

DOI: 10.1016/j.jscai.2025.103989