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Imaging to Assess Ischemic Heart Disease in Women

  • Women and Ischemic Heart Disease (E. Jackson, Section Editor)
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Abstract

Purpose of Review

Ischemic heart disease is a leading cause of morbidity and mortality for women and men around the world. However, traditional cardiovascular risk factors do not fully capture cardiac risk in women. This review summarizes sex-based differences in the clinical presentation, pathophysiology, and risk assessment of ischemic heart disease. We also examine the use of anatomic and functional imaging modalities in the diagnosis of ischemic heart disease in women.

Recent Findings

Recent studies with women subjects have bolstered the predictive value of the coronary artery calcium (CAC) score in predicting atherosclerotic cardiovascular disease risk and major adverse cardiac events in a graded fashion. In addition, combined CAC scoring and coronary computed tomography (CCTA) has shown promise in excluding coronary artery disease (CAD). Using CCTA, data have suggested that increasing cardiovascular risk factors are associated with an increase in noncalcified coronary plaque in women compared with an increase in both calcified and noncalcified plaque in men with cardiac risk factors. Some data have suggested that women obtain greater prognostic benefit from CCTA than from other noninvasive tests. Fractional flow reserve obtained from a CCTA (FFRCT) is a new mathematical assessment of coronary blood flow that determines the presence of lesion-specific myocardial ischemia.

Summary

Prevention and identification of ischemic heart disease remains a foundation of cardiology and public health. In women, atypical symptoms and limitations in traditional risk factor assessment lead to challenges in the identification of ischemic heart disease. With improvements in technologies such as CAC scoring, CCTA, instantaneous flow reserve (iFR), optical coherence tomography (OCT), and FFRCT, there is great promise for identification of ischemic heart disease, and the future of prevention in women. Future studies with strong female representation should investigate the role of novel imaging techniques in women.

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Authors and Affiliations

  1. Department of Cardiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 1305 York Avenue, WGC-8, New York, NY, 10021, USA

    Kaartiga Sivanesan, Subhi J. Al’Aref, Jessica M. Peña & Erica C. Jones

  2. Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA

    Subhi J. Al’Aref, James K. Min, Jessica M. Peña, Fay Lin & Erica C. Jones

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  1. Kaartiga Sivanesan
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  2. Subhi J. Al’Aref
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Correspondence to Erica C. Jones.

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Kaartiga Sivanesan, Subhi Al’Alref, Jessica M. Peña, and Fay Lin declare no conflict of interest.

Erica Jones is employed by the Dalio Institute of Cardiovascular Imaging at NewYork Presbyterian Hospital. Dr. James Min, the Director of the Dalio ICI, is the PI of the CONFIRM trial, which is referenced in our review. James K. Min reports and has ownership in MDDX, serves on the scientific advisory board of Arineta, and has a research agreement with GE healthcare.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Women and Ischemic Heart Disease

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Sivanesan, K., Al’Aref, S.J., Min, J.K. et al. Imaging to Assess Ischemic Heart Disease in Women. Curr Atheroscler Rep 20, 16 (2018). https://doi.org/10.1007/s11883-018-0714-1

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