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CLINICAL RESEARCH

Effect of a change in gender on coronary arterial size

A longitudinal intravascular ultrasound study in transplanted hearts

^* Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA

Manuscript received November 20, 2000; revised manuscript received April 18, 2002, accepted October 25, 2002.

^* Reprint requests and correspondence: Dr. Niall A. Herity, Department of Cardiology, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland.
Niall.Herity{at}bch.n-i.nhs.uk

OBJECTIVES: We sought to document whether a physiologic change in gender has any effect on coronary arterial size.

BACKGROUND: The coronary arteries are smaller in women, even after correction for body surface area (BSA). These differences may contribute to adverse clinical outcomes after coronary artery bypass graft surgery and myocardial infarction in women. In male and female transsexuals, pharmacologic doses of estrogens and androgens significantly influence vascular diameter. Thus, gender differences in the coronary vasculature may be a reflection of the hormonal environment.

METHODS: In 86 patients who had undergone orthotopic heart transplantation, serial intravascular ultrasound studies of the proximal left anterior descending coronary artery (LAD) were analyzed. Changes in vessel area (VA) over the first or second post-transplant year were recorded, and comparisons were made between donor hearts that were transplanted in a patient of the same gender and those that were transplanted in a patient of the opposite gender.

RESULTS: Vessel area of the proximal LAD increased over time in all patient groups. In hearts transplanted within the same gender and in male donor hearts transplanted to female recipients, the change was small and not significant. However, in hearts transplanted from female donors to male recipients, there was a substantial and highly significant increase in LAD VA (median 16.13 to 17.88 mm²; p = 0.01). This increase was not explained by confounding due to changes in BSA or left ventricular wall thickness.

CONCLUSIONS: This pattern of arterial remodeling early after heart transplantation supports a link between host gender and coronary arterial size.

Abbreviations and Acronyms   BSA = body surface area   CABG = coronary artery bypass graft surgery   CAD = coronary artery disease   CsA = cyclosporin A   IVUS = intravascular ultrasound   LAD = left anterior descending coronary artery   LMCA = left main coronary artery   LV = left ventricular   MI = myocardial infarction   VA = vessel area

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