Cardiovascular imaging in women

Cardiovascular disease (CVD) remains the leading cause of death in the United States and globally, with more women than men dying from the disease. Sex-specific differences in cardiovascular anatomy and physiology, hormonal influences, and life-stage-related risk factors such as menarche, pregnancy, breastfeeding, and menopause, play a key role in this sex-based disparity, and systemic factors such as delays in clinical recognition, diagnosis, treatment, and clinical trial representation further widen this gap. Appropriate multimodality imaging plays a pivotal role in bridging these gaps, offering improved diagnostic accuracy and guiding optimal risk stratification. Various imaging techniques-including echocardiography, computed tomography, magnetic resonance imaging, invasive coronary angiography, and nuclear imaging-provide complementary insights into cardiovascular health in women. Recent advancements, including artificial intelligence-driven imaging, offer promising opportunities to further enhance diagnostic accuracy and personalized care. This review examines the role of multimodality imaging in diagnosing and managing cardiovascular diseases that disproportionately affect women. It highlights key sex-based considerations, emerging trends, and advancements in imaging technology. Understanding these sex-specific differences is critical for enhancing diagnostic accuracy, refining risk assessment models, and guiding treatment strategies, with the ultimate aim of improving cardiovascular health care and outcomes in women.