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Gender-related imaging issues in assessment of coronary artery disease by nuclear techniques
1Division of Cardiovascular Diseases, University of Iowa, Iowa City 52242-1081, USA.
Insights
Cardiovascular nuclear testing can evaluate heart disease in women. Myocardial perfusion imaging is recommended over radionuclide angiocardiography for detecting coronary artery disease in women.
Area of Science:
- Cardiology
- Nuclear Medicine
- Women's Health
Background:
- Heart disease poses a significant threat to women's health, yet its noninvasive evaluation remains challenging.
- Cardiovascular nuclear tests assess consequences of coronary artery disease (CAD), including myocardial blood flow, ejection fraction, wall motion, and myocardial viability.
Purpose of the Study:
- To review cardiovascular nuclear testing methods for assessing coronary artery disease (CAD) in women.
- To compare the effectiveness of different nuclear imaging techniques for diagnosing significant CAD in the female population.
Main Methods:
- Review of published studies on cardiovascular nuclear testing in women.
- Discussion of concepts and radionuclides used in nuclear cardiology.
- Analysis of myocardial perfusion imaging and radionuclide angiocardiography for CAD detection.
Main Results:
- Myocardial perfusion imaging is a suitable test for detecting CAD in women, accounting for breast tissue attenuation artifacts.
- Intravenous dipyridamole stress shows comparable accuracy in women and men, though women report more side effects.
- Limited gender-specific data exist for adenosine, 99mTc, and positron-emitting tracers; exercise radionuclide angiography offers limited prognostic value in women.
Conclusions:
- Myocardial perfusion imaging is generally preferable to radionuclide angiocardiography for detecting significant CAD in women.
- Future studies must analyze diagnostic testing data separately for women and men to determine optimal evaluation methods for CAD in women.
Abstract:
Heart disease is a major threat to women's health. However, noninvasive evaluation of women for the presence of significant heart disease is often problematic. Cardiovascular nuclear tests interrogate different consequences of physiologically significant coronary artery disease (CAD). Myocardial perfusion imaging supplies information about regional myocardial blood flow. Radionuclide angiocardiography provides information about ejection fraction and regional wall motion. Infarct and metabolic imaging yield information about myocardial viability. This article briefly discusses the concepts and radionuclides involved in cardiovascular nuclear testing and reviews published studies as they relate to assessment of coronary artery disease in women. Myocardial perfusion imaging is a reasonable test for detection of coronary artery disease in women, especially when attenuation artifacts from breast tissue are taken into account. Intravenous dipyridamole stress provides comparable overall accuracy in women and men although women reportedly have a higher incidence of side effects; gender-specific data have not been reported for adenosine. Sufficient gender-specific data are also not currently available for either 99mTc or positron-emitting perfusion tracers. Exercise radionuclide angiography can help determine the probability of significant left main or severe three vessel disease but provides only limited prognostic information in women with CAD. Thus in women, although choice of testing using nuclear techniques depends in part on local experience and expertise, myocardial perfusion imaging appears preferable to radionuclide angiocardiography for detection of significant CAD. To determine the most accurate methods to evaluate women for the presence of significant CAD, all current and future studies of diagnostic testing for CAD should analyze data separately for women and men.