1354212 - Sex-Differences in Stress Burden and Markers of Cardiac Inflammation —A Cardiovascular Magnetic Resonance Imaging Study

Stress has been associated with the incidence of cardiovascular disease (CVD), with women experiencing nearly twice as many stress disorders in their lifetime as men (1,2).  CVD is the leading cause of death in women and female-specific risk factors have helped to understand this trend further (3). However, whether stress is one of the mechanisms explaining increased CVD mortality and adverse prognosis in women needs further investigation. CMR is the reference standard for quantifying cardiac inflammation. Specifically, important advancements in CMR technology have allowed for high resolution and clinically applicable quantitative T1 and T2 mapping techniques for the detection of cardiac inflammation (4). The present study aims to identify sex differences in the impact of stress burden, as measured by Perceived Stress Scale (PSS) scores, on markers of cardiac inflammation, in females and males.  

Methods:

In this single-centre prospective study, we analyzed T1 and T2 maps performed on a 3T GE scanner in patients with CVD and healthy participants who had previously completed the PSS questionnaire. PSS is a globally used and self-reported scale measuring perceived stress that exhibits strong psychometric properties with good reliability and high construct validity (5). All images were assessed for global values using cvi⁴² (Circle CVI, Calgary, AB, Canada). Analyses were stratified by sex and PSS groups (PSS score< 14: low-stress group, PSS ≥14: higher stress group). An independent samples t-test was used to compare T1 global mean values and T2 global mean values between males and females in both low and higher stress groups. Values are reported as mean± standard deviation. Multiple linear regression analysis was used to investigate the associations. 

Results:

We studied 41 patients (mean age 57.27±10.7 years, 37% females) and 21 healthy participants (mean age 50.43 ±10.9 years, 43% females). In the higher stress group (n=33, 55% females), in comparison to males, females had higher T1 global values (mean T1 global 1246.2±51.2 vs. 1191.2±45.0ms; p=0.002) and T2 global values (mean T2 global 49.02±3.8 vs 45.04±4.5ms; p=0.013) despite similar stress levels (PSS  19.67±3.7 vs 19.53±3.7) (Panel Figure). There was no such difference in the lower stress group (n=28, 21% females). A sex and age-adjusted linear regression model, with PSS scores as a covariate, significantly predicted T1 (R² = 0.869, p=0.017) and T2 (R² = 0.902, p=0.008) values.

Conclusion:

Our data indicate that in females, high levels of stress have a stronger impact on markers of cardiac inflammation than in males. This sex-related difference in the relationship between stress burden and inflammation may contribute to the observed increased CVD mortality and morbidity in females.