Impact of sex on the assessment of the microvascular resistance reserve

Coen K. M. Boerhout, C. E. M. Vink, Joo Myung Lee, Guus A. de Waard, Hernan Mejia-Renteria, Seung Hun Lee, Ji-Hyun Jung, Masahiro Hoshino, Mauro Echavarria-Pinto, M. Meuwissen, Hitoshi Matsuo, Maribel Madera-Cambero, Ashkan Eftekhari, Mohamed A. Effat, Tadashi Murai, Koen Marques, Joon-Hyung Doh, Evald H. Christiansen, Rupak Banerjee, Chang-Wook NamGiampaolo Niccoli, Masafumi Nakayama, Nobuhiro Tanaka, Eun-Seok Shin, Yolande Appelman, Marcel A. M. Beijk, Niels van Royen, Steven A. J. Chamuleau, Paul Knaapen, Javier Escaned, Tsunekazu Kakuta, Bon Kwon Koo, Jan J. Piek, Tim P. van de Hoef

Research output: Contribution to journalArticleAcademicpeer-review


Background: The microvascular resistance reserve (MRR) is an innovative index to assess the vasodilatory capacity of the coronary circulation while accounting for the presence of concomitant epicardial disease. The MRR has shown to be a valuable diagnostic and prognostic tool in the general coronary artery disease (CAD) population. However, considering the fundamental aspects of its assessment and the unique hemodynamic characteristics of women, it is crucial to provide additional considerations for evaluating the MRR specifically in women. Aim: The aim of this study was to assess the diagnostic and prognostic applicability of the MRR in women and assess the potential differences across different sexes. Methods: From the ILIAS Registry, we enrolled all patients with a stable indication for invasive coronary angiography, ensuring complete physiological and follow-up data. We analyzed the diagnostic value by comparing differences between sexes and evaluated the prognostic value of the MRR specifically in women, comparing it to that in men. Results: A total of 1494 patients were included of which 26% were women. The correlation between MRR and CFR was good and similar between women (r = 0.80, p < 0.005) and men (r = 0.81, p < 0.005). The MRR was an independent and important predictor of MACE in both women (HR 0.67, 0.47–0.96, p = 0.027) and men (HR 0.84, 0.74–0.95, p = 0.007). The optimal cut-off value for MRR in women was 2.8 and 3.2 in men. An abnormal MRR similarly predicted MACE at 5-year follow-up in both women and men. Conclusion: The MRR seems to be equally applicable in both women and men with stable coronary artery disease.

Original languageEnglish
Article number131832
JournalInternational journal of cardiology
Early online date2024
Publication statusPublished - 1 May 2024


  • CFR
  • CMD
  • Chronic coronary syndromes
  • MRR
  • Sex differences

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