Gaine Sean Paul, Sharma Garima, Tower-Rader Albree, Botros Mina, Kovell Lara, Parakh Anushri, Wood Malissa J, Harrington Colleen M
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Cardiovasc Dev Dis. 2022 Oct 13;9(10):350. doi: 10.3390/jcdd9100350.
Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction.
与男性相比，患有冠状动脉疾病的女性往往有更差的短期和长期预后，且动脉粥样硬化性心血管疾病的发病率正在上升。与男性相比，女性出现典型心绞痛症状的可能性较小，更容易被误诊。有几种非侵入性成像方式可用于诊断女性缺血性心脏病，其中许多方式还可辅助进行预后评估并有助于指导治疗。选择最佳成像方式来评估可能患有缺血性心脏病的女性是临床医生经常遇到的情况。早期的方式如运动平板试验在男性和女性中的表现差异很大，而较新的方式如冠状动脉CT血管造影、心肌灌注成像和心脏磁共振成像对缺血和冠状动脉疾病的检测具有高度特异性和敏感性，且两性之间的差异较小。个体因素、可及性、诊断性能以及诸如妊娠状态等女性特有的因素可能会影响选择一种方式而非另一种方式的决定。诸如应变率成像、CT心肌灌注成像和心脏磁共振成像等新兴技术为诊断缺血和冠状动脉微血管功能障碍提供了更多选择。
