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Coronary Artery Disease in Women: Lessons Learned from Single-Center SPECT Registry and Future Directions for INOCA
Barbara Vitola1,2, Karlis Trusinskis1,2, Iveta Mintale1,3
1Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia.
Insights
Cardiac SPECT accurately detects myocardial perfusion defects in women. Further invasive testing is crucial for diagnosing ischemia with nonobstructive coronary artery disease (INOCA) and tailoring treatment.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cardiac single-photon emission tomography (SPECT) is effective for detecting coronary artery disease (CAD) in women.
- A significant number of women with perfusion defects on SPECT lack obstructive CAD, a condition known as ischemia with nonobstructive coronary artery disease (INOCA).
- Current diagnostic and therapeutic strategies for INOCA are insufficient due to underdiagnosis of its specific endotypes.
Purpose of the Study:
- To evaluate the role of cardiac SPECT in identifying women with potential INOCA.
- To assess the correlation between SPECT findings, clinical characteristics, and cardiovascular risk factors in women.
- To identify candidates for invasive microvascular physiology measurements for INOCA diagnosis.
Main Methods:
- Analysis of 726 women with suspected CAD who underwent cardiac SPECT between 2018 and 2021.
- Coronary angiography was performed to assess for obstructive CAD.
- Patients meeting INOCA criteria were selected for further invasive diagnostic testing.
Main Results:
- True myocardial perfusion defects were identified in 17.2% of women.
- 56.0% of women with perfusion defects showed no obstructive epicardial coronary artery disease (CAD).
- Perfusion defects correlated with cardiovascular risk factors like obesity and hypertension; typical angina was associated with INOCA.
Conclusions:
- Cardiac SPECT plays a vital role in identifying women with potential INOCA.
- There is a significant need for invasive physiological measurements to diagnose INOCA.
- Combining SPECT with invasive testing could revolutionize INOCA patient management and improve outcomes.
Abstract:
Background and objectives: Myocardial perfusion imaging with cardiac single-photon emission tomography (SPECT) is widely available for the detection of coronary artery disease (CAD) with high diagnostic and prognostic accuracy for women. A large proportion of symptomatic women with true myocardial perfusion defects in SPECT referred to coronary angiography have an absence of CAD-a condition named INOCA (ischemia with nonobstructive CAD). Additionally, the INOCA endotypes are rarely correctly diagnosed, and therefore, no tailored therapy is prescribed. Materials and methods: The cardiac SPECT for women was performed from 2018 to 2021. Patients with perfusion defect were analyzed according to further prescribed diagnostic tests used to diagnose CAD. According to the diagnostic criteria, patients with INOCA were selected as candidates for invasive microvascular physiology measurements. The correlation was calculated between SPECT results and clinical characteristics, symptoms, and risk factors. Results: A total of 726 women with suspected CAD were analyzed. True myocardial perfusion defects were detected in 125 patients (17.2%). During coronary angiography in 70 (56.0%) women, atherosclerosis in epicardial arteries was not observed. In 17 (20.9%) patients, obstructive CAD was present. Correlation was found between perfusion defect in SPECT and cardiovascular risk factors, including overweight, obesity, arterial hypertension, and dyslipidemia. Women with typical angina were more likely to have INOCA, but with "noncardiac" symptoms-CAD. In total, 68 female patients met three inclusion criteria for INOCA and were selected as candidates for invasive diagnostic testing. Conclusions: The created registry proves the important role of cardiac SPECT and great need for the development of invasively detected physiological measurements. The combination of both interventions could significantly change the future directions for INOCA patients, improving treatment strategies and clinical outcomes, especially knowing the number of risk factors and varying clinical presentation. The study will be continued by performing invasive testing of coronary microvascular function to expand the competence about what is known about INOCA patients.
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