Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Medicine, Cardiovascular Division, Orlando VA Medical Center, Orlando, Florida, USA.
JACC Cardiovasc Imaging. 2022 Aug;15(8):1488-1501. doi: 10.1016/j.jcmg.2022.01.006. Epub 2022 Mar 16.
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 compared with 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 in women in accordance to the recently published American Heart Association/American College of Cardiology guidelines for the evaluation and diagnosis of chest pain. 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 and myocardial infarction with nonobstructive CAD.
心脏病是男性和女性的主要死因。与男性相比，女性的缺血性心脏病具有独特的表型，其钙化病变较少，非阻塞性斑块更多，微血管疾病的患病率更高，这可能部分解释了为什么目前用于检测阻塞性冠状动脉疾病（CAD）的风险模型在女性中效果不佳。本文总结了在稳定型胸痛女性中 CAD 的功能和解剖评估方面的性别差异，并根据美国心脏协会/美国心脏病学会最近发布的胸痛评估和诊断指南，为女性疑似缺血性心脏病的多模态成像评估提供了一种方法。需要对女性缺血性心脏病的影像学方法进行范式转变，包括更新的风险模型、更深入地了解非阻塞性疾病更为普遍的女性 CAD，以及专注于评估非阻塞性 CAD 导致的缺血和非阻塞性 CAD 导致的心肌梗死的算法。
