Optimizing Risk Stratification and Noninvasive Diagnosis of Ischemic Heart Disease in Women

Garuba, Habibat A.; Erthal, Fernanda; Stadnick, Ellamae; Alzahrani, Ahmad A.; Chow, Benjamin J.W.; deKemp, Robert A.

doi:10.1016/j.cjca.2018.01.026

Cited by 6 publications

(4 citation statements)

References 72 publications

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“…On the contrary, a 0-calcium score represents a very good prognosis. The prognostic value of coronary calcium is independent of sex, although men tend to have higher calcium scores for each vessel and higher mean total calcium scores compared to women [ 57 ].…”

Section: Nuclear Imaging Techniquesmentioning

confidence: 99%

Cardiac Imaging in Women with Ischemic Heart Disease

Peix¹

2023

Life

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Cardiac diseases are the main cause of death for both sexes worldwide. Treatment varies widely according to the sex of a patient, as there are differences in physiopathology, epidemiology, clinical presentation and management. However, women have been largely excluded from research studies in this field. At present, differences are starting to be recognized and more attention is being paid to the identification of female-specific (or emergent) atherosclerotic risk factors. Diagnostic testing also merits attention because cardiac imaging offers important information to help diagnosis and guide cardiac disease management. In this sense, multimodal imaging should be used with the most cost-effective approach, integrating this information into the clinical sphere according to the pretest probability of the disease. In this review, we address sex-specific features of ischemic heart disease that should be considered in the clinical assessment of women, as well as the value of different imaging techniques (including technical and clinical aspects) for management of women with ischemic heart disease, and identify future areas of action concerning ischemic heart disease in women.

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Section: Nuclear Imaging Techniquesmentioning

confidence: 99%

Cardiac Imaging in Women with Ischemic Heart Disease

Peix¹

2023

Life

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“…Another limitation of SPECT in women is breast tissue attenuation which can mimic perfusion defects, classically in the anterior wall [ 93 ]. Several techniques help to reduce attenuation artifacts including image acquisition in prone position, breast bandage, and CT-based attenuation correction [ 94 ]. Combining CT with SPECT also allows quantifying intrathoracic fat and CACS, which provide incremental prognostic value for MACE in women [ 95 ].…”

Section: Sex Differences In Cardiovascular Diseases and Their Impact ...mentioning

confidence: 99%

Imaging of heart disease in women: review and case presentation

Mikaïl

Rossi

Bengs

et al. 2022

Eur J Nucl Med Mol Imaging

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Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.

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“…Pathophysiologically, women are more prone to microvascular affectation than men, 8 and have some risk factors that have been identified as increasing the risk of CVD in women, including preterm delivery, pre‐eclampsia, gestational diabetes and polycystic ovary syndrome. However, these factors are not included in primary prevention risk stratification tools 9 .…”

Section: Introductionmentioning

confidence: 99%

“…6 Particularly, oestrogen deprivation at menopause has a cluster of adverse effects on cardiovascular structure, function and metabolism, including alterations in body fat volume and distribution, endothelial dysfunction, vascular inflammation, sympathetic tone and a higher insulin resistance, contributing to hypertension and lipid metabolism alterations. 7 Pathophysiologically, women are more prone to microvascular affectation than men, 8 and have some risk factors that have been identified as increasing the risk of CVD in women, including preterm delivery, pre-eclampsia, gestational diabetes and polycystic ovary syndrome. However, these factors are not included in primary prevention risk stratification tools.…”

Section: Introductionmentioning

confidence: 99%

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

Mazón‐Ramos

Aldana

Garcia‐Vega

et al. 2023

Eur J Clin Investigation

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AimsTo assess the longer‐term results (hospital admissions and mortality) in women versus men referred to a cardiology department from primary care using an e‐consultation in our outpatient care programme.MethodsWe selected 61,306 patients (30,312 women and 30,994 men) who visited the cardiology service at least once between 2010 and 2021: 69.1% (19,997 women and 20,462 men) were attended in e‐consultation (from 2013 to 2021) and 30.9% (8920 women and 9136 men) in in‐person consultations (from 2010 to 2012) without gender differences in the proportion of patients attended in each period. Using an interrupted time series regression model, we analysed the impact of incorporating e‐consultation into the healthcare model and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all‐cause hospital admissions and mortality during the one‐year after cardiology consultation.ResultsThe introduction of e‐consultation substantially decreased waiting times to cardiology care; during the in‐person consultation period, the mean delay for cardiology care was 57.9 (24.8) days in men and 55.8 (22.8) days in women. During the e‐consultation period, the waiting time to cardiology care was markedly reduced to 9.41 (4.02) days in men and 9.46 (4.18) in women. After e‐consultation implantation, there was a significant reduction in the 1‐year rate of hospital admissions and mortality, both in women and men iRR [IC 95%]: 0.95 [0.93–0.96] for HF, 0.90 [0.89–0.91] for CV and 0.70 [0.69–0.71] for all‐cause hospitalization; and 0.93 [0.92–0.95] for HF, 0.86 [0.86–0.87] for CV and 0.88 [0.87–0.89] for all‐cause mortality in women; and 0.91 [0.89–0.92] for HF, 0.90 [0.89–0.91] for CV and 0.72 [0.71–0.73] for all‐cause hospitalization; and 0.96 [0.93–0.97] for HF, 0.87 [95% CI: 0.86–0.87] for CV and 0.87 [0.86–0.87] for all‐cause mortality, in men.ConclusionCompared with the in‐person consultation period, an outpatient care programme that includes an e‐consultation significantly reduced waiting time to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year, without significative gender differences.

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Optimizing Risk Stratification and Noninvasive Diagnosis of Ischemic Heart Disease in Women

Cited by 6 publications

References 72 publications

Cardiac Imaging in Women with Ischemic Heart Disease

Cardiac Imaging in Women with Ischemic Heart Disease

Imaging of heart disease in women: review and case presentation

Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area

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