Cardiac Imaging in Women with Suspected Ischemic Heart Disease

Cardiovascular imaging has undergone advances over the past decades and is increasingly used for the diagnosis of atherosclerotic disease in men and women. Recent guidelines suggest the use of stress imaging in symptomatic women at intermediate or high pretest probability of having ischemic heart disease, as well as the use of coronary computed tomography angiography to delineate the presence and location of coronary plaque. There are differences in pathophysiology of atherosclerotic disease in women, as women are more likely to have nonobstructive disease, often caused by abnormal coronary reactivity, microvascular dysfunction, as well as plaque erosion and distal microembolization. Myocardial perfusion imaging with positron emission tomography (PET) or magnetic resonance imaging (MRI) can aid in the diagnosis of microvascular dysfunction, making it even more valuable in women for an earlier and more accurate diagnosis leading to improved management and outcomes in women.