Available online 23 February 2024

Author links open overlay panel, , , ,

Multimodality cardiovascular imaging is a cornerstone diagnostic tool in the diagnosis, risk stratification, and management of cardiovascular diseases, whether those involving the coronary tree, myocardial, or pericardial diseases in general and particularly in women. This manuscript aims to shed some light and summarize the very features of cardiovascular disease in women, explore their unique characteristics and discuss the role of cardiovascular imaging in ischemic heart disease and cardiomyopathies. The role of four imaging modalities will be discussed including nuclear medicine, echocardiography, noninvasive coronary angiography, and cardiac magnetic resonance.

Section snippetsIntroduction, Cardiovascular Diseases in Women

Cardiovascular diseases (CVDs) are the leading cause of death in both men and women, reaching 19.1 million deaths/year globally.1 Death is an accurate measure of CVD outcomes and thus, it reflects disease burden. CVD is the most common cause of death in countries which are members of the European Society of Cardiology, with ischemic heart disease (IHD)accounting for 45% of deaths in females and 39% in males. Thirty-five percent of all deaths in women worldwide are due to cardiovascular

Ischemic Heart disease

When addressing the diagnosis and management of IHD in women, one should consider the pathophysiologic differences between the two genders mentioned previously. Since women have less obstructive epicardial disease and more diffuse disease, functional testing rather than anatomical imaging modalities might be more appropriate. In addition, women have smaller caliber vessels and that should be taken into account when choosing a test.31,32 Guidelines of multiple societies have emphasized the

Computed Tomography in the Diagnosis of Heart Disease

Cardiac computed tomography angiography, is in the first steps during evaluation of patients presenting with chest pain, who have low- to- intermediate risk for the presence of coronary artery disease.79,33 This imaging modality has a high diagnostic accuracy for the detection of CAD in the general population. Owing to the smaller vessel caliber and higher heart rate in women compared to men (resulting in motion artifacts), this diagnostic accuracy is affected (Fig. 3). One of the parameters

Magnetic Resonance for the Diagnosis of Heart Disease in Women

The American Heart Association (AHA) chest-pain guidelines state the utility of cardiac magnetic resonance imaging (CMRI) in the evaluation of patients in specific scenarios.

The leading role in the evaluation of the functional impact of a coronary stenosis is by the stress-CMR (S-CMR), even according to imaging guidelines.88 S-CMR is a functional method which, after the induction of a pharmacological stress, allows us to identify any perfusion defects and wall motion abnormalities.89 S-CMR has

Echocardiography for the Diagnosis of Heart Diseases

Echocardiography is a well-established imaging modality for the evaluation of ventricular volumes, structure, valves, systolic, and diastolic functions, regional wall motion abnormalities in case of ischemic cardiomyopathies, and the evaluation of pulmonary arterial hypertension.

Systemic Diseases Involving the Cardiovascular System

Systemic diseases usually affect multiple organs including the heart. Numerous theories have been suggested including intracellular and extracellular interaction, autoimmune reactions, inflammatory substances, and some genetic mutations.

Two main diseases will be discussed in this section.

Conclusion

IHD in women is far from being rare. We have witnessed in the last few years different pathophysiology for the disease other than obstructive CAD, reflected by microvascular dysfunction, vasomotor incompetence, and all the spectrum of INOCA including spontaneous coronary artery dissection driven by the female hormonal influence. In addition, unique female related heart diseases are present such as, peripartum cardiomyopathy and takotsubo cardiomyopathy. Therefore, the conventional diagnostic

CRediT authorship contribution statement

Samia Massalha: Writing – review & editing, Writing – original draft. John Kennedy: Writing – review & editing. Essam Hussein: Writing – review & editing. Besma Mahida: Writing – review & editing. Zohar Keidar: Supervision.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

View full text

© 2024 Elsevier Inc. All rights reserved.