Loma Linda University Health, Loma Linda CA.
Beth Israel deaconess medical center, Harvard Medical School, Boston, MA.
J Thorac Imaging. 2023 Jul 1;38(4):204-211. doi: 10.1097/RTI.0000000000000719. Epub 2023 May 29.
Approach to imaging ischemia in women Coronary artery disease in women tends to have a worse short- and long-term prognosis relative to men and remains the leading cause of mortality worldwide. Both clinical symptoms and diagnostic approach remain challenging in women due to lesser likelihood of women presenting with classic anginal symptoms on one hand and underperformance of conventional exercise treadmill testing in women on the other. Moreover, a higher proportion of women with signs and symptoms suggestive of ischemia are more likely to have nonobstructive coronary artery disease (CAD) that requires additional imaging and therapeutic considerations. New imaging techniques such as coronary computed tomography (CT) angiography, CT myocardial perfusion imaging, CT functional flow reserve assessment, and cardiac magnetic resonance imaging carry substantially better sensitivity and specificity for the detection of ischemia and coronary artery disease in women. Familiarity with various clinical subtypes of ischemic heart disease in women and with the major advantages and disadvantages of advanced imaging tests to ensure the decision to select one modality over another is one of the keys to successful diagnosis of CAD in women. This review compares the 2 major types of ischemic heart disease in women - obstructive and nonobstructive, while focusing on sex-specific elements of its pathophysiology.
女性缺血性疾病的影像学检查方法
相较于男性，女性的冠状动脉疾病具有更差的短期和长期预后，且仍然是全球范围内导致死亡的主要原因。由于女性发生典型心绞痛症状的可能性较小，且常规运动平板试验在女性中的表现不佳，因此在女性中，临床症状和诊断方法仍然具有挑战性。此外，有迹象和症状表明存在缺血的女性中，更有可能患有非阻塞性冠状动脉疾病（CAD），需要进行额外的影像学和治疗考虑。新的影像学技术，如冠状动脉计算机断层扫描（CT）血管造影、CT 心肌灌注成像、CT 功能血流储备评估和心脏磁共振成像，对于检测女性的缺血和冠状动脉疾病具有更高的敏感性和特异性。熟悉女性缺血性心脏病的各种临床亚型以及高级影像学检查的主要优缺点，以确保选择一种检查方法而不是另一种检查方法的决策，是女性 CAD 成功诊断的关键之一。本文比较了女性两种主要类型的缺血性心脏病——阻塞性和非阻塞性，并重点介绍了其病理生理学的性别特异性因素。
