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[Intracoronary imaging in women]
Serigne C T Ndao1, Nicolas Amabile1
1Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
Insights
Intracoronary imaging (ICI) offers significant benefits for women with coronary artery disease, despite being underutilized. Further research and integration are crucial to improve cardiovascular outcomes and reduce care disparities.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Women's Health
Background:
- Coronary artery disease (CAD) is a leading cause of mortality in women, often underestimated.
- Atypical pathophysiological mechanisms in women necessitate advanced diagnostic tools beyond traditional angiography.
- Intracoronary imaging techniques (ICI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), offer complementary insights.
Purpose of the Study:
- To review current data on ICI use in women.
- To highlight the benefits, limitations, and sex-specific considerations of ICI in female patients.
- To analyze the underutilization of ICI in women and propose strategies for improved integration.
Main Methods:
- Narrative review of recent scientific literature.
- Inclusion of observational studies, post-hoc analyses of randomized trials, and registries.
- Focus on the application and outcomes of IVUS and OCT in women.
Main Results:
- Women exhibit distinct coronary anatomy and plaque characteristics (e.g., erosions over ruptures) poorly visualized by angiography alone.
- ICI is particularly valuable for diagnosing MINOCA and SCAD in women.
- Despite clinical benefits, ICI is underused in women, with low trial representation and limited routine practice adoption.
- Complications of ICI are rare and comparable between sexes when anatomical precautions are taken.
Conclusions:
- ICI presents a significant, underutilized opportunity to enhance cardiovascular outcomes in women.
- Improved integration of ICI into clinical practice and more gender-specific research are essential.
- Addressing disparities in cardiovascular care for women requires better utilization of advanced imaging technologies.
Background:
Coronary artery disease remains the leading cause of mortality among women, despite a persistent underestimation of its clinical impact. Intracoronary imaging techniques (ICI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have emerged as valuable tools to complement angiography, especially in women, whose pathophysiological mechanisms are often atypical.
Aims:
To analyse current data on the use of ICI in women and highlight its benefits, limitations, and sex-specific considerations.
Methods:
Narrative review of recent literature, including observational studies, post-hoc analyses of randomized trials, and registries focusing on IVUS and OCT use in women.
Results:
Women tend to have smaller coronary arteries, less extensive atherosclerotic disease, and distinct plaque composition, with a predominance of erosions over ruptures. These characteristics are poorly assessed by angiography alone, reinforcing the value of ICI, particularly in cases of MINOCA and spontaneous coronary artery dissection (SCAD). Despite demonstrated clinical benefits, ICI remains underused in women, with lower penetration into routine practice and underrepresentation in clinical trials. Complications related to intracoronary imaging are rare and comparable between genders, if precautions specific to female anatomy are observed.
Conclusion:
ICI represents a significant yet underutilized opportunity to improve cardiovascular outcomes in women. Better integration of this technology into diagnostic and therapeutic strategies, combined with more gender-specific research, is essential to reduce persistent disparities in care.
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