Skip to main content
SpringerLink
Log in

State of the Art in Noninvasive Imaging of Ischemic Heart Disease and Coronary Microvascular Dysfunction in Women: Indications, Performance, and Limitations

  • Women and Ischemic Heart Disease (P. Kohli , Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Establishing a diagnosis of ischemic heart disease (IHD) in women, including assessment for coronary microvascular dysfunction (CMD) when indicated, can be challenging. Access to performance of invasive testing when appropriate may be limited, and noninvasive imaging assessments have evolved. This review will summarize the various noninvasive imaging modalities available for the diagnosis of IHD and CMD in women, outlining indications, performance modalities, advantages, and limitations.

Recent Findings

While stress echocardiography and single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) are widely available and can detect IHD in women, their ability to specifically identify CMD is limited. Novel developments in cardiac magnetic resonance (CMR) imaging, including spectroscopy, and positron emission tomography (PET) have changed the diagnostic landscape. Coronary computed tomographic angiography (CCTA), while unable to diagnose CMD, is developing an emerging role in the risk stratification of ischemic syndromes.

Summary

Despite the discovery of increased CMD prevalence in symptomatic women and technological advances in diagnostic imaging, practitioners are limited by user expertise and center availability when choosing a diagnostic imaging modality. Knowledge of this evolving field is imperative as it highlights the need for sex-specific assessment of cardiovascular syndromes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 Update: a report from the American Heart Association. Vol 141; 2020. https://doi.org/10.1161/CIR.0000000000000757.

  2. Izadnegahdar M, Singer J, Lee MK, Gao M, Thompson CR, Kopec J, et al. Do younger women fare worse? Sex differences in acute myocardial infarction hospitalization and early mortality rates over ten years. J Women's Health. 2014;23(1):10–7. https://doi.org/10.1089/jwh.2013.4507.

    Article  Google Scholar 

  3. Mehta LS, Beckie TM, DeVon HA, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Vol 133; 2016. https://doi.org/10.1161/CIR.0000000000000351.

  4. Norris CM, Yip CYY, Nerenberg KA, Clavel MA, Pacheco C, Foulds HJA, et al. State of the science in women’s cardiovascular disease: a Canadian perspective on the influence of sex and gender. J Am Heart Assoc. 2020;9(4):1–18. https://doi.org/10.1161/JAHA.119.015634.

    Article  Google Scholar 

  5. •• Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation. 2019;139(18):E891–908. https://doi.org/10.1161/CIR.0000000000000670A contemporary statement that defines MINOCA (myocardial infarction without obstructive disease) and provides a comprehensive framework and algorithm for diagnostic evaluation and management of these patients.

    Article  Google Scholar 

  6. Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, et al. Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease insights from the PROMISE trial. JACC Cardiovasc Imaging. 2016;9(4):337–46. https://doi.org/10.1016/j.jcmg.2016.02.001.

    Article  Google Scholar 

  7. •• Mieres JH, Gulati M, Merz NB, et al. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease a consensus statement from the American Heart Association. Circulation. 2014;130:350–79. https://doi.org/10.1161/CIR.0000000000000061This consensus statement by the American Heart Association, is the only clinical statement specific to women with ischemic heart disease, and guides the reader through various imaging tests and recommended algorithms in female patients with anginal symptoms covering the gamut of obstructive and nonobstructive disease.

    Article  Google Scholar 

  8. Noel Bairey Merz C, Pepine CJ, Walsh MN, Fleg JL. Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade. Circulation. 2017;135(11):1075–92. https://doi.org/10.1161/CIRCULATIONAHA.116.024534.

    Article  Google Scholar 

  9. Pacheco Claudio C, Quesada O, Pepine CJ, Noel Bairey Merz C. Why names matter for women: MINOCA/INOCA (myocardial infarction/ischemia and no obstructive coronary artery disease). Clin Cardiol 2018;41(2):185–193. doi:https://doi.org/10.1002/clc.22894.

  10. Gulati M, Shaw LJ, Handberg EM, et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease. Arch Intern Med. 2009;169(9):843–50.

    Article  Google Scholar 

  11. • Baldassarre LA, Raman SV, Min JK, et al. Noninvasive imaging to evaluate women with stable ischemic heart disease. JACC Cardiovasc Imaging. 2017;9(4):421–35. https://doi.org/10.1016/j.jcmg.2016.01.004.NoninvasiveAn inclusive paper summarizing the importance of sex-specific tagrets in non-invasive imaging of CAD as well as anatomical and functional differences between modalities.

    Article  Google Scholar 

  12. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das S. Heart disease and stroke statistics — 2017 update a report from the American Heart Association. Circulation. 2017;135:146–603. https://doi.org/10.1161/CIR.0000000000000485.

    Article  Google Scholar 

  13. Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol. 2018;41(2):239–46. https://doi.org/10.1002/clc.22887.

    Article  Google Scholar 

  14. Maffei S, Guiducci L, Cugusi L, Cadeddu C, Deidda M, Gallina S, et al. Women-specific predictors of cardiovascular disease risk - new paradigms. Int J Cardiol. 2019;286:190–7. https://doi.org/10.1016/j.ijcard.2019.02.005.

    Article  Google Scholar 

  15. Young L, Cho L. Unique cardiovascular risk factors in women. Heart. 2019;105:1656–60. https://doi.org/10.1136/heartjnl-2018-314268.

    Article  CAS  Google Scholar 

  16. Camici PG, Amati G, Rimoldi O. Coronary microvascular dysfunction: mechanisms and functional assessment. Nat Rev Cardiol. 2015;12:48–62. https://doi.org/10.1038/nrcardio.2014.160.

    Article  Google Scholar 

  17. •• Ford TJ, Yii E, Sidik N, et al. Ischemia and no obstructive coronary artery disease: prevalence and correlates of coronary vasomotion disorders. Circ Cardiovasc Interv. 2019;12(12). https://doi.org/10.1161/CIRCINTERVENTIONS.119.008126This multicenter study encompassing 391 patients with angina, demonstrated patients without obstructive disease (47%) had similar angina burden, were more likely to be female, and often had microvascular and vasospastic angina, and had reduced quality of life compared to those with obstructive disease.

  18. • Aziz A, Hansen HS, Sechtem U, Prescott E, Ong P. Sex-related differences in vasomotor function in patients with angina and unobstructed coronary arteries. JACC. 2017;70(19):2349–58. https://doi.org/10.1016/j.jacc.2017.09.016Using an ACH test to assess for vasospasm or coronary microvascular dysfunction (CMD) in patients with stable non-obstructive angina, this retrospecive study of 1379 patients identifies a higher prevalence of vasomotor dysfunction (especially CMD) in females compared with male patients.

    Article  Google Scholar 

  19. • Ong P, Camici PG, Beltrame JF, et al. International standardization of diagnostic criteria for microvascular angina. Int J Cardiol. 2018;250:16–20. https://doi.org/10.1016/j.ijcard.2017.08.068This landmark paper which emerged from Coronary Vasomotion Disorders International Study Group (COVADIS) Summits held in August 2014, establishes an international diagnostic criteria for ischemic symptoms due to coronary microvascular dysfunction (CMD).

    Article  Google Scholar 

  20. Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34(1):48–55. https://doi.org/10.1016/0002-9149(74)90092-7.

    Article  CAS  Google Scholar 

  21. Kern MJ, Bach RG, Mechem CJ, Caracciolo EA, Aguirre FV, Miller LW, et al. Variations in normal coronary vasodilatory reserve stratified by artery, gender, heart transplantation and coronary artery disease. J Am Coll Cardiol. 1996;28(5):1154–60. https://doi.org/10.1016/S0735-1097(96)00327-0.

    Article  CAS  Google Scholar 

  22. Gould KL. Does coronary flow trump coronary anatomy? JACC Cardiovasc Imaging. 2009;2(8):1009–23. https://doi.org/10.1016/j.jcmg.2009.06.004.

    Article  Google Scholar 

  23. Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813–22.

    Article  CAS  Google Scholar 

  24. Kwok Y, Kim C, Grady D, Segal M, Redberg R. Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol. 1999;83(5):660–6. https://doi.org/10.1016/S0002-9149(98)00963-1.

    Article  CAS  Google Scholar 

  25. Gulati M, Pandey DK, Arnsdorf MF, Lauderdale DS, Thisted RA, Wicklund RH, et al. Exercise capacity and the risk of death in women: the St. James Women Take Heart Project. Circulation. 2003;108(13):1554–9. https://doi.org/10.1161/01.CIR.0000091080.57509.E9.

    Article  Google Scholar 

  26. Kohli P, Gulati M. Exercise stress testing in women: going back to the basics. Circulation. 2010;122(24):2570–80. https://doi.org/10.1161/CIRCULATIONAHA.109.914754.

    Article  Google Scholar 

  27. • Garuba HA, Erthal F, Stadnick E, Alzahrani A, Chow B, Beanlands RS. Optimizing risk stratification and noninvasive diagnosis of ischemic heart disease in women. Can J Cardiol. 2018;34(4):400–12. https://doi.org/10.1016/j.cjca.2018.01.026A comprehensive summary that highlights sex specific differences in pathophysiology, risk factors, presentation of CAD along with diagnostic modalities that can help risk stratify women.

    Article  Google Scholar 

  28. Mulvagh SL, Rakowski H, Vannan MA, Abdelmoneim SS, Becher H, Bierig SM, et al. American Society of Echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr. 2008;21(11):1179–201. https://doi.org/10.1016/j.echo.2008.09.009.

    Article  Google Scholar 

  29. Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, et al. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr. 2018;31(3):241–74. https://doi.org/10.1016/j.echo.2017.11.013.

    Article  Google Scholar 

  30. Abdelmoneim SS, Ball CA, Mantovani F, Hagen ME, Eifert-Rain S, Wilansky S, et al. Prognostic utility of stress testing and cardiac biomarkers in menopausal women at low to intermediate risk for coronary artery disease (SMART study): 5-year outcome. J Women's Health. 2018;27(5):542–51. https://doi.org/10.1089/jwh.2017.6506.

    Article  Google Scholar 

  31. Hardegree EL, Sachdev A, Fenstad ER, Villarraga HR, Frantz RP, McGoon MD, et al. Impaired left ventricular mechanics in pulmonary arterial hypertension identification of a cohort at high risk. Circ Heart Fail. 2013;6(4):748–55. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000098.

    Article  Google Scholar 

  32. Laiq Z, Smith LM, Xie F, Chamsi-Pasha M, Porter TR. Differences in patient outcomes after conventional versus real time perfusion stress echocardiography in men versus women: a prospective randomised trial. Heart. 2015;101(7):559–64. https://doi.org/10.1136/heartjnl-2014-306869.

    Article  Google Scholar 

  33. • Kutty S, Bisselou Moukagna KS, Craft M, Shostrom V, Xie F, Porter TR. Clinical outcome of patients with inducible capillary blood flow abnormalities during demand stress in the presence or absence of angiographic coronary disease. Circ Cardiovasc Imaging. 2018;11(10):e007483. https://doi.org/10.1161/CIRCIMAGING.117.007483This study concludes that patients who have capillary blood flow abnormalities with non-obstructive CAD (majority women) have similar death/ nonfatal myocardial infarction rates compared to those with significant obstructive CAD.

    Article  Google Scholar 

  34. From AM, Kane G, Bruce C, Pellikka PA, Scott C, McCully RB. Characteristics and outcomes of patients with abnormal stress echocardiograms and angiographically mild coronary artery disease (<50% stenoses) or normal coronary arteries. J Am Soc Echocardiogr. 2010;23(2):207–14. https://doi.org/10.1016/j.echo.2009.11.023.

    Article  Google Scholar 

  35. •• Taqueti VR, Dorbala S, Wolinsky D, et al. Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease—state-of-the-evidence and clinical recommendations. J Nucl Cardiol. 2017;24(4):1402–26. https://doi.org/10.1007/s12350-017-0926-8A consensus document by the American Society of Nuclear Cardiology on the evidence base of stress myocardial perfusion imaging, and addition of PET based coronary flow imaging for optimal risk stratification of women with stable ischemic heart disease.

    Article  Google Scholar 

  36. Iskandar A, Limone B, Parker MW, Perugini A, Kim H, Jones C, et al. Gender differences in the diagnostic accuracy of SPECT myocardial perfusion imaging: a bivariate meta-analysis. J Nucl Cardiol. 2013;20(1):53–63. https://doi.org/10.1007/s12350-012-9646-2.

    Article  Google Scholar 

  37. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11(2):171–85. https://doi.org/10.1016/j.nuclcard.2003.12.004.

    Article  Google Scholar 

  38. Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography. A Meta-Analysis. J Am Coll Cardiol. 2007;49(2):227–37. https://doi.org/10.1016/j.jacc.2006.08.048.

    Article  Google Scholar 

  39. Cassar A, Chareonthaitawee P, Rihal CS, Prasad A, Lennon RJ, Lerman LO, et al. Lack of correlation between noninvasive stress tests and invasive coronary vasomotor dysfunction in patients with nonobstructive coronary artery disease. Circ Cardiovasc Interv. 2009;2(3):237–44. https://doi.org/10.1161/CIRCINTERVENTIONS.108.841056.

    Article  Google Scholar 

  40. Shaw LJ, Mieres JH, Hendel RH, Boden WE, Gulati M, Veledar E, et al. Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the what is the optimal method for ischemia evaluation. Circulation. 2011;124(11):1239–49. https://doi.org/10.1161/CIRCULATIONAHA.111.029660.

    Article  Google Scholar 

  41. Greenwood JP, Motwani M, Maredia N, Brown JM, Everett CC, Nixon J, et al. Comparison of cardiovascular magnetic resonance and single-photon emission computed tomography in women with suspected coronary artery disease from the clinical evaluation of magnetic resonance imaging in coronary heart disease (CE-MARC) trial. Circulation. 2014;129(10):1129–38. https://doi.org/10.1161/CIRCULATIONAHA.112.000071.

    Article  Google Scholar 

  42. Phillips LM. CZT-SPECT: reaching its potential. JACC Cardiovasc Imaging. 2017;10(7):795–6. https://doi.org/10.1016/j.jcmg.2017.02.003.

    Article  Google Scholar 

  43. Nudi F, Iskandrian AE, Schillaci O, Peruzzi M, Frati G, Biondi-Zoccai G. Diagnostic accuracy of myocardial perfusion imaging with CZT technology: systemic review and meta-analysis of comparison with invasive coronary angiography. JACC Cardiovasc Imaging. 2017;10(7):787–94. https://doi.org/10.1016/j.jcmg.2016.10.023.

    Article  Google Scholar 

  44. Gimelli A, Bottai M, Quaranta A, Giorgetti A, Genovesi D, Marzullo P. Gender differences in the evaluation of coronary artery disease with a cadmium-zinc telluride camera. Eur J Nucl Med Mol Imaging. 2013;40(10):1542–8. https://doi.org/10.1007/s00259-013-2449-0.

    Article  CAS  Google Scholar 

  45. Gulati M, Shaw LJ, Merz CNB. Myocardial ischemia in women: lessons from the NHLBI WISE study. Clin Cardiol. 2012;35(3):141–8. https://doi.org/10.1002/clc.21966.

    Article  Google Scholar 

  46. DeKemp RA, Wells RG, Beanlands RS. Women image wisely the 3 mSv challenge for nuclear cardiology. JACC Cardiovasc Imaging. 2016;9(4):385–7. https://doi.org/10.1016/j.jcmg.2016.02.018.

    Article  Google Scholar 

  47. •• Aggarwal NR, Bond RM, Mieres JH. The role of imaging in women with ischemic heart disease. Clin Cardiol. 2018;41(2):194–202. https://doi.org/10.1002/clc.22913. An excellent review that summarizes different imaging modalities across the full spectrum of ischemic heart disease in women, including coronary atherosclerosis and microvascular disease.

  48. Reynolds HR, Srichai MB, Iqbal SN, et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124(13):1414–25. https://doi.org/10.1161/CIRCULATIONAHA.111.026542.

    Article  Google Scholar 

  49. Lanza GA, Buffon A, Sestito A, Natale L, Sgueglia GA, Galiuto L, et al. Relation between stress-induced myocardial perfusion defects on cardiovascular magnetic resonance and coronary microvascular dysfunction in patients with cardiac syndrome X. J Am Coll Cardiol. 2008;51(4):466–72. https://doi.org/10.1016/j.jacc.2007.08.060.

    Article  Google Scholar 

  50. Coelho-Filho OR, Seabra LF, Mongeon FP, Abdullah SM, Francis SA, Blankstein R, et al. Stress myocardial perfusion imaging by CMR provides strong prognostic value to cardiac events regardless of patient’s sex. JACC Cardiovasc Imaging. 2011;4(8):850–61. https://doi.org/10.1016/j.jcmg.2011.04.015.

    Article  Google Scholar 

  51. Johnson BD, Shaw LJ, Buchthal SD, Bairey Merz CN, Kim HW, Scott KN, et al. Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: results from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored women’s ischemia syndrome evaluation (WISE). Circulation. 2004;109(24):2993–9. https://doi.org/10.1161/01.CIR.0000130642.79868.B2.

    Article  Google Scholar 

  52. Morton G, Chiribiri A, Ishida M, Hussain ST, Schuster A, Indermuehle A, et al. Quantification of absolute myocardial perfusion in patients with coronary artery disease: comparison between cardiovascular magnetic resonance and positron emission tomography. J Am Coll Cardiol. 2012;60(16):1546–55. https://doi.org/10.1016/j.jacc.2012.05.052.

    Article  Google Scholar 

  53. Danad I, Raijmakers PG, Driessen RS, Leipsic J, Raju R, Naoum C, et al. Comparison of coronary CT angiography, SPECT, PET, and hybrid imaging for diagnosis of ischemic heart disease determined by fractional flow reserve. JAMA Cardiol. 2017;2(10):1100–7. https://doi.org/10.1001/jamacardio.2017.2471.

    Article  Google Scholar 

  54. Shaw LJ, Olson MB, Kip K, Kelsey SF, Johnson BD, Mark DB, et al. The value of estimated functional capacity in estimating outcome: results from the NHBLI-sponsored women’s ischemia syndrome evaluation (WISE) study. J Am Coll Cardiol. 2006;47(3 SUPPL):S36–43. https://doi.org/10.1016/j.jacc.2005.03.080.

    Article  Google Scholar 

  55. Sampson UK, Dorbala S, Limaye A, Kwong R, Di Carli MF. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/computed tomography in the detection of coronary artery disease. J Am Coll Cardiol. 2007;49(10):1052–8. https://doi.org/10.1016/j.jacc.2006.12.015.

    Article  CAS  Google Scholar 

  56. Skinner JS, Smeeth L, Kendall JM, Adams PC, Timmis A. NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Heart. 2010;96(12):974–8. https://doi.org/10.1136/hrt.2009.190066.

    Article  Google Scholar 

  57. Xu R, Li C, Qian J, Ge J. Computed tomography-derived fractional flow reserve in the detection of lesion-specific ischemia an integrated analysis of 3 pivotal trials. Medicine (Baltimore). 2015;94(46):1–8. https://doi.org/10.1097/MD.0000000000001963.

    Article  Google Scholar 

  58. Crea F, Camici PG, Noel C, Merz B. Clinical update coronary microvascular dysfunction: an update. Eur Heart J. 2014;35:1101–11. https://doi.org/10.1093/eurheartj/eht513.

    Article  Google Scholar 

  59. Michelsen MM, Mygind ND, Pena A, Aziz A, Frestad D, Høst N, et al. Peripheral reactive hyperemia index and coronary microvascular function in women with no obstructive CAD the iPOWER study. JACC Cardiovasc Imaging. 2016;9(4):411–7. https://doi.org/10.1016/j.jcmg.2016.02.005.

    Article  Google Scholar 

  60. • Ciampi Q, Zagatina A, Cortigiani L, et al. Functional, anatomical, and prognostic correlates of coronary flow velocity reserve during stress echocardiography. J Am Coll Cardiol. 2019;74(18):2278–91. https://doi.org/10.1016/j.jacc.2019.08.1046A prospective, multi-center study of 3410 patients determines that coronary flow velocity reserve obtained from stress echo, shows independent value over regional wall motion abnormality when predicting adverse cardiovascular outcomes.

    Article  CAS  Google Scholar 

  61. Mulvagh SL, Mokhtar AT. Coronary flow velocity reserve in stress echocardiography: time to go with the global flow? J Am Coll Cardiol. 2019;74(18):2292–4. https://doi.org/10.1016/j.jacc.2019.08.1042.

    Article  Google Scholar 

  62. Wells RG, Marvin B, Poirier M, Renaud J, DeKemp RA, Ruddy TD. Optimization of SPECT measurement of myocardial blood flow with corrections for attenuation, motion, and blood binding compared with PET. J Nucl Med. 2017;58(12):2013–9. https://doi.org/10.2967/jnumed.117.191049.

    Article  CAS  Google Scholar 

  63. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, di Carli G, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124(20):2215–24. https://doi.org/10.1161/CIRCULATIONAHA.111.050427.

    Article  Google Scholar 

  64. Jerosch-Herold M, Vazquez G, Wang L, Jacobs DR, Folsom AR. Variability of myocardial blood flow measurements by magnetic resonance imaging in the multi-ethnic study of atherosclerosis. Investig Radiol. 2008;43(3):155–61. https://doi.org/10.1097/RLI.0b013e31815abebd.

    Article  Google Scholar 

  65. Mauricio R, Srichai MB, Axel L, Hochman JS, Reynolds HR. Stress cardiac MRI in women with myocardial infarction and nonobstructive coronary artery disease. Clin Cardiol. 2016;39(10):596–602. https://doi.org/10.1002/clc.22571.

    Article  Google Scholar 

  66. Buchthal SD, Den Hollander JA, Merz CNB, et al. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. N Engl J Med. 2000;342(12):829–35. https://doi.org/10.1056/NEJM200003233421201.

    Article  CAS  Google Scholar 

  67. Johnson BD, Shaw LJ, Buchthal SD, Bairey Merz CN, Kim HW, Scott KN, et al. Prognosis in women with myocardial ischemia in the absence of obstructive coronary disease: results from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored women’s ischemia syndrome evaluation (WISE). Circulation. 2004;109(24):2993–9. https://doi.org/10.1161/01.CIR.0000130642.79868.B2.

    Article  Google Scholar 

  68. Puchner DKK, Birch LL. High-risk plaque detected on coronary computed tomography angiography predicts acute coronary syndrome independent of significant stenosis in patients with acute chest pain – results from ROMICAT II trial. J Am Coll Cardiol. 2014;64(12):2391–404. https://doi.org/10.1038/jid.2014.371.

    Article  CAS  Google Scholar 

  69. • Ferencik M, Mayrhofer T, Bittner DO, et al. Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the promise randomized clinical trial. JAMA Cardiol. 2018;3(2):144–52. https://doi.org/10.1001/jamacardio.2017.4973This study highlights that high risk plaque identified by coronary CTA is associated with greater MACE in patients with stable chest pain especially in those with nonobstructive coronary artery disease, younger patients, and women.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada

    Priya Koilpillai

  2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Niti R. Aggarwal & Sharon L. Mulvagh

  3. Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Center, Halifax Infirmary Site, Dalhousie University, 1796 Summer Street, Suite 2148.5, Halifax, NS, B3H 3A7, Canada

    Sharon L. Mulvagh

Authors
  1. Priya Koilpillai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niti R. Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sharon L. Mulvagh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sharon L. Mulvagh.

Ethics declarations

Conflict of Interest

Sharon L. Mulvagh reports personal fees from Lantheus Medical Imaging and Novo Nordisk outside the submitted work. Priya Koilpillai and Niti R. Aggarwal declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

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

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koilpillai, P., Aggarwal, N.R. & Mulvagh, S.L. State of the Art in Noninvasive Imaging of Ischemic Heart Disease and Coronary Microvascular Dysfunction in Women: Indications, Performance, and Limitations. Curr Atheroscler Rep 22, 73 (2020). https://doi.org/10.1007/s11883-020-00894-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11883-020-00894-0

Keywords

Search

Navigation