Cardiovascular disease in women: insights from magnetic resonance imaging
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Cardiovascular disease in women: insights from magnetic resonance imaging Chiara Bucciarelli-Ducci1, Ellen Ostenfeld2* , Lauren A. Baldassarre3, Vanessa M. Ferreira4, Luba Frank5, Kimberly Kallianos6, Subha V. Raman7, Monvadi B. Srichai8, Elisa McAlindon9, Sophie Mavrogeni10, Ntobeko A. B. Ntusi11, Jeanette Schulz-Menger12, Anne Marie Valente13 and Karen G. Ordovas6
Abstract The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement. This article reviews the sex differences in cardiovascular disease, explores the diagnostic and prognostic role of cardiovascular magnetic resonance (CMR) in the spectrum of cardiovascular disorders in women, and proposes the added value of CMR compared to other imaging modalities. In addition, this article specifically reviews the role of CMR in cardiovascular diseases occurring more frequently or exclusively in female patients, including Takotsubo cardiomyopathy, connective tissue disorders, primary pulmonary arterial hypertension and peripartum cardiomyopathy. Gaps in knowledge and opportunities for further investigation of sex-specific cardiovascular differences by CMR are also highlighted. Keywords: Cardiovascular magnetic resonance, Female cardiovascular disease, Ischemic heart disease, Non-ischemic cardiomyopathies, Peripartum cardiomyopathy, Chemotherapy-induced cardiomyopathy, Congenital heart disease, Turner syndrome, Connective tissue disease, Pulmonary hypertension
Background Women are commonly underrepresented in cardiovascular research, comprising as little as 15–35% of populations in randomized clinical trials [1], and when included, are most often in the postmenopausal stage of life [2]. Even though both men and women are affected by cardiovascular disease, there are only limited numbers of sex-specific and age-balanced imaging and management guidelines for women with cardiovascular disease [2]. In the setting of growing awareness of providing personalized precision medicine, addressing sex differences in cardiovascular disease is a key goal [1]. Anatomically, women have smaller hearts even after adjustment for body size, and, as a result, have different disease phenotypes, which may influence the choice and * Correspondence: [email protected] 2 Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Getingevägen 5, SE-22185 Lund, Sweden Full list of author information is available at the end of the article
accuracy of diagnostic tests. Further, there are intrinsic imaging difficulties with transthoracic echocardiography in women due to reduced image quality from breast tissue attenuation and reluctance to use cardiac computed tomography (CCT) in pre-menopausal women due to breast tissue sensitivity. Cardiovascular magnetic resonance (CMR) imaging provides a comprehensive evaluation of cardiovascular disease, including assessment of m
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