State-of-the-Art: Cardiovascular Imaging for Ischemic Heart Disease in Women: Time for a Paradigm shift

• Published in: JACC. Cardiovascular imaging 2022-03, Vol.15 (8), p.1488-1501
• Main Authors: Rodriguez Lozano, Patricia F., Kaso, Elona Rrapo, Bourque, Jamieson M., Morsy, Mohamed, Taylor, Angela M., Villines, Todd C., Kramer, Christopher M., Salerno, Michael
• Format: Article
• Language: English
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2022.01.006

Heart disease is the leading cause of death among men and women. Women have a unique phenotype of ischemic heart disease with less calcified lesions, more nonobstructive plaques, and a higher prevalence of microvascular disease as compared to men, which may explain in part why current risk models to detect obstructive coronary artery disease (CAD) may not work as well in women. This paper summarizes the sex differences in the functional and anatomical assessment of CAD in women presenting with stable chest pain and provides an approach for using multimodality imaging for the evaluation of suspected ischemic heart disease (IHD) in women in accordance to the recent published AHA/ACC guidelines for the evaluation and Diagnosis of Chest Pain.[ 1 ]. A paradigm shift in the approach to imaging ischemic heart disease women is needed including updated risk models, a more profound understanding of CAD in women where nonobstructive disease is more prevalent, and algorithms focused on the evaluation of ischemia with nonobstructive CAD (INOCA) and Myocardial infarction with nonobstructive CAD (MINOCA).