Imaging Tests, Provocative Tests, Including Exercise Testing in Women with Suspected Coronary Artery Disease
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SECONDARY INTERVENTION (JM FOODY, SECTION EDITOR)
Imaging Tests, Provocative Tests, Including Exercise Testing in Women with Suspected Coronary Artery Disease Eleni Vavas & Susie N. Hong & Sonia Henry & Stacey E. Rosen & Jennifer H. Mieres
Published online: 15 July 2012 # The Author(s) 2012. This article is published with open access at Springerlink.com
Abstract Evolving knowledge regarding sex differences in coronary heart disease has demonstrated that the prevalence, symptomatology, and pathophysiology of coronary atherosclerosis vary between genders. Women experience higher mortality rates and more adverse outcomes after acute myocardial infarction than men, despite a lower prevalence of obstructive coronary artery disease. Based on recent insights into the complex pathophysiology of coronary heart disease which includes a spectrum of obstructive coronary artery disease and
dysfunction of the coronary microvasculature and endothelium, the term ischemic heart disease is a more accurate term for discussion of coronary atherosclerosis specific to women. In women, with clinical features and risk factors for ischemic heart disease, the detection and evaluation of ischemic heart disease is challenging due to the diverse pathogenic mechanisms of ischemic heart diseases in women. In this article, we discuss noninvasive imaging tests, provocative tests, including exercise testing in women with suspected ischemic heart disease. Keywords Noninvasive imaging . Sex-specific . Women
E. Vavas (*) Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA e-mail: [email protected] S. N. Hong Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA e-mail: [email protected] S. Henry : S. E. Rosen Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA S. Henry e-mail: [email protected] S. E. Rosen e-mail: [email protected] J. H. Mieres Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, 1979 Marcus Avenue Suite 236, Lake Success, NY 11042, USA e-mail: [email protected]
Introduction Marked reductions in cardiovascular mortality in women have occurred for the first time in the past decade due to an increase in awareness, greater focus on prevention strategies as well as the application of evidence-based treatments for established coronary artery disease (CAD) [1–3]. Despite this progress, CAD is still the leading cause of death and disability in the United States, claiming the lives of almost 200,000 women every year [4–7]. The focus on sex-specific cardiovascular disease research has greatly improved our understanding of the pathophysiology of coronary disease in women [4]. The Women’s Ischemia Syndrome Evaluation (WISE) trial and related studies have expanded our understanding of the complex pathophysiology of coronary atherosclerosis in women to include abnormal coronary reactivity [8], microvascular dysfunction [9], and plaque erosion/distal microembolization
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