Noninvasive Diagnostic Techniques for Coronary Disease in Women

Abstract

Significant advances in medical treatment, medical technology, and the focus on sex-specific research have contributed to a reduction in cardiovascular mortality in women. Despite these advances, coronary artery disease (CAD) is the leading cause of cardiovascular death of women in the Western world. In the past 2 decades, the focused research on women at risk for CAD has helped to clarify our understanding of some of the sex-specific factors that are important in the detection of CAD. In women, the detection and evaluation of physiologically significant CAD can be challenging. Many of the traditional tests that are designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients, who have a greater burden of symptoms, higher atherosclerotic burden, and lower prevalence of obstructive coronary disease. In this article, we review the available evidence on the role of contemporary noninvasive diagnostic techniques in the evaluation of women with symptoms of CAD.

Sex‐Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003–2012

“…27 Furthermore, identifying the etiology of arrest as ischemic can be quite challenging despite advances in diagnostic tools. 28 Our finding that women compared with men are less likely to present with a shockable VT/VF rhythm has been reported in several studies. 22,29,30 Prior investigations also suggested that women have fewer arrests witnessed by bystanders, and are more likely to present with arrests at home.…”

“…Warning symptoms preceding cardiac arrest differ in men and women; women tend to experience more atypical symptoms, such as dyspnea, and less chest pain compared with men . Furthermore, identifying the etiology of arrest as ischemic can be quite challenging despite advances in diagnostic tools . Our finding that women compared with men are less likely to present with a shockable VT/VF rhythm has been reported in several studies .…”

Role of Echocardiography in the Management of Cardiac Disease in Women

“…Stress echocardiography, using exercise or dobutamine- or adenosine-mediated vasodilation, has been established as an accurate, noninvasive test for diagnosing coronary heart disease in women. 44) 45) 46) 47) The development of new, abnormal, regional wall motion during or after stress is considered an indication of myocardial ischemia. The reported sensitivity and specificity of stress echocardiography for diagnosing coronary disease ranges from 80-85%.…”

Exercise test predictors of severe coronary artery disease: Role of ST‐segment elevation in lead aVR

“…ST‐segment depression (STD) induced during an exercise stress test (EST) is considered the most valuable electrocardiographic (ECG) abnormality for the diagnosis of myocardial (subendocardial) ischemia, and therefore of obstructive coronary artery disease (CAD) …”

“…ST-segment depression (STD) induced during an exercise stress test (EST) is considered the most valuable electrocardiographic (ECG) abnormality for the diagnosis of myocardial (subendocardial) ischemia, and therefore of obstructive coronary artery disease (CAD). [1][2][3] Lead aVR is usually excluded from routine analysis of ESTinduced ST-segment changes. Due to its axis orientation (+210 ), indeed, aVR is believed to not explore any specific region of the heart and have poor association with myocardial ischemia.…”