{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:30:46Z","timestamp":1786476646055,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary microvascular dysfunction (CMVD) is prevalent in non\u2010obstructive coronary artery disease (NOCAD), and potential sex\u2010related determinants remain incompletely characterized. This study explored sex\u2010specific associations with abnormal myocardial flow reserve (MFR) using cadmium\u2010zinc\u2010telluride single\u2010photon emission computed tomography (CZT\u2010SPECT) in a real\u2010world cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 393 NOCAD patients (56.7% female) undergoing CZT\u2010SPECT. Abnormal MFR was defined as &lt;\u20092.5. Candidate variables were identified through group comparisons (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.10) and univariate logistic regression, followed by multicollinearity assessment. A pooled multivariable logistic regression model incorporating main effects and sex interaction terms was constructed. Receiver operating characteristic (ROC) analysis evaluated discriminatory performance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Abnormal MFR was observed in 49.1% of patients. In the multivariable model, LDL\u2010C was associated with abnormal MFR (OR: 1.471, 95% CI: 1.072\u20132.018;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017). A significant sex\u2009\u00d7\u2009MDRD\u2010eGFR interaction was identified (OR: 1.024, 95% CI: 1.003\u20131.046;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026), with a borderline sex\u2009\u00d7\u2009LDL\u2010C interaction (OR: 0.650;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.089). The overall model demonstrated moderate discrimination (AUC: 0.680). In females, LDL\u2010C showed modest discriminatory ability (AUC: 0.586). Among patients with abnormal MFR, females exhibited higher LCX and RCA territory resting myocardial blood flow and higher E\/e', and RCA\u2010rMBF was inversely correlated with E\/e'.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sex\u2010modified associations of renal and lipid parameters with abnormal MFR were observed in this cohort. These interaction patterns and female\u2010specific phenotypes provide preliminary insights into cardiorenal\u2010microvascular relationships in CMVD, but should be interpreted as exploratory and hypothesis\u2010generating and warrant further validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70294","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T13:59:57Z","timestamp":1776952797000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex\u2010Specific Associations With Abnormal Myocardial Flow Reserve in Non\u2010Obstructive Coronary Artery Disease: Insights From a Real\u2010World Cadmium\u2010Zinc\u2010Telluride SPECT Study"],"prefix":"10.1002","volume":"49","author":[{"given":"Ya\u2010Jie","family":"Wang","sequence":"first","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular Disease, Department of Cardiology Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University Tianjin China"},{"name":"Department of Cardiology TEDA International Cardiovascular Hospital, Clinical Cardiovascular Institute of Tianjin Medical University Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian\u2010Ming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine TEDA International Cardiovascular Hospital, Clinical Cardiovascular Institute of Tianjin Medical University Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Wu","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0482-0738","authenticated-orcid":false,"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular Disease, Department of Cardiology Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang\u2010Yin","family":"Chen","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ionic\u2010Molecular Function of Cardiovascular Disease, Department of Cardiology Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University Tianjin 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