Cardiovascular Imaging for Ischemic Heart Disease in Women: Time for a Paradigm Shift

Area of Science:

• Cardiology
• Medical Imaging
• Women's Health

Background:

• Heart disease remains a leading cause of mortality globally.
• Women exhibit distinct ischemic heart disease (IHD) phenotypes, including less calcified lesions, more nonobstructive plaques, and higher rates of microvascular disease compared to men.
• These differences may limit the efficacy of current obstructive coronary artery disease (CAD) risk models in women.

Purpose of the Study:

• To summarize sex differences in the functional and anatomical assessment of CAD in women with stable chest pain.
• To propose an approach utilizing multimodality imaging for evaluating suspected IHD in women, aligning with recent AHA/ACC guidelines.
• To advocate for a paradigm shift in IHD imaging for women, emphasizing updated risk models and understanding nonobstructive CAD.

Main Methods:

• Review of current literature on sex differences in CAD presentation and assessment.
• Synthesis of data regarding functional and anatomical evaluation of CAD in women.
• Application of recent American Heart Association/American College of Cardiology guidelines for chest pain evaluation.

Main Results:

• Women's unique CAD phenotype includes less calcified lesions and a higher prevalence of microvascular disease.
• Current risk stratification models may underestimate CAD risk in women due to these differences.
• Multimodality imaging offers a comprehensive approach to assess IHD in women.

Conclusions:

• A paradigm shift is required for diagnosing IHD in women, moving beyond traditional obstructive CAD assessment.
• Updated risk models and a deeper understanding of nonobstructive CAD are crucial.
• Algorithms focusing on ischemia with nonobstructive CAD (INOCA) and myocardial infarction with nonobstructive CAD (MINOCA) are essential for accurate diagnosis and management in women.