Parry Monica, Van Spall Harriette G C, Mullen Kerri-Anne, Mulvagh Sharon L, Pacheco Christine, Colella Tracey J F, Clavel Marie-Annick, Jaffer Shahin, Foulds Heather J A, Grewal Jasmine, Hardy Marsha, Price Jennifer A D, Levinsson Anna L E, Gonsalves Christine A, Norris Colleen M
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
CJC Open. 2022 Apr 19;4(7):589-608. doi: 10.1016/j.cjco.2022.04.002. eCollection 2022 Jul.
This chapter summarizes the sex- and gender-specific diagnosis and treatment of acute/unstable presentations and nacute/stable presentations of cardiovascular disease in women. Guidelines, scientific statements, systematic reviews/meta-analyses, and primary research studies related to diagnosis and treatment of coronary artery disease, cerebrovascular disease (stroke), valvular heart disease, and heart failure in women were reviewed. The evidence is summarized as a narrative, and when available, sex- and gender-specific practice and research recommendations are provided. Acute coronary syndrome presentations and emergency department delays are different in women than they are in men. Coronary angiography remains the gold-standard test for diagnosis of obstructive coronary artery disease. Other diagnostic imaging modalities for ischemic heart disease detection (eg, positron emission tomography, echocardiography, single-photon emission computed tomography, cardiovascular magnetic resonance, coronary computed tomography angiography) have been shown to be useful in women, with their selection dependent upon both the goal of the individualized assessment and the testing resources available. Noncontrast computed tomography and computed tomography angiography are used to diagnose stroke in women. Although sex-specific differences appear to exist in the efficacy of standard treatments for diverse presentations of acute coronary syndrome, many cardiovascular drugs and interventions tested in clinical trials were not powered to detect sex-specific differences, and knowledge gaps remain. Similarly, although knowledge is evolving about sex-specific difference in the management of valvular heart disease, and heart failure with both reduced and preserved ejection fraction, current guidelines are lacking in sex-specific recommendations, and more research is needed.
本章总结了女性心血管疾病急性/不稳定表现和非急性/稳定表现的性别特异性诊断与治疗。对与女性冠状动脉疾病、脑血管疾病（中风）、心脏瓣膜病和心力衰竭的诊断和治疗相关的指南、科学声明、系统评价/荟萃分析及原始研究进行了综述。证据以叙述形式总结，并在可行时提供性别特异性的实践和研究建议。女性急性冠状动脉综合征的表现及急诊科延误情况与男性不同。冠状动脉造影仍是诊断阻塞性冠状动脉疾病的金标准检查。其他用于检测缺血性心脏病的诊断成像方法（如正电子发射断层扫描、超声心动图、单光子发射计算机断层扫描、心血管磁共振、冠状动脉计算机断层扫描血管造影）已证明对女性有用，其选择取决于个体化评估的目标和可用的检测资源。非增强计算机断层扫描和计算机断层扫描血管造影用于诊断女性中风。尽管在急性冠状动脉综合征不同表现的标准治疗效果方面似乎存在性别差异，但许多在临床试验中测试的心血管药物和干预措施未设定检测性别差异的效力，知识差距仍然存在。同样，尽管关于心脏瓣膜病以及射血分数降低和保留的心力衰竭管理中的性别差异的知识不断发展，但当前指南缺乏性别特异性建议，仍需要更多研究。
