Imaging of Ischemic Heart Disease in Women: A Critical Review of the Literature

By IAEA

This publication examines the special characteristics of the pathophysiology of coronary artery disease (CAD) and its clinical presentation in women, which differ from those of men. While coronary obstruction and multi-vessel disease are more common in men, non-ischemic heart disease (IHD) best encompasses the spectrum of the disease in women. The publication provides a critical review of the existing literature, covering some general aspects of the disease as well as how to make a diagnosis/prognosis of IHD, both clinical and by means of cardiac imaging. The specific situation of cardiac imaging in the management of IHD in low- or middle- income countries is surveyed. In addition, reference is made to cardiotoxicity and radiotherapy-induced disease in breast cancer.

• Language: English
• Publisher: International Atomic Energy Agency
• Release date: Dec 12, 2022
• ISBN: 9789201299222

Book preview

1.png

IMAGING OF ISCHEMIC

HEART DISEASE IN WOMEN:

A CRITICAL REVIEW OF THE

LITERATURE

IAEA HUMAN HEALTH SERIES No. 40

IMAGING OF ISCHEMIC

HEART DISEASE IN WOMEN:

A CRITICAL REVIEW OF THE

LITERATURE

INTERNATIONAL ATOMIC ENERGY AGENCY

VIENNA, 2022

COPYRIGHT NOTICE

All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at:

Marketing and Sales Unit, Publishing Section

International Atomic Energy Agency

Vienna International Centre

PO Box 100

1400 Vienna, Austria

fax: [phone]

tel.: [phone]

email: [e-mail]

www.iaea.org/publications

© IAEA, 2022

Printed by the IAEA in Austria

December 2022

STI/PUB/1970

IAEA Library Cataloguing in Publication Data

Names: International Atomic Energy Agency.

Title: Imaging of Ischemic Heart Disease in Women: A Critical Review of the Literature / International Atomic Energy Agency.

Description: Vienna : International Atomic Energy Agency, 2022. | Series: IAEA human health series, ISSN 2075–3772 ; no. 40 | Includes bibliographical references.

Identifiers: IAEAL 22-01559 | ISBN 978–92–0–129722–8 (paperback : alk. paper) | ISBN 978–92–0–129822–5 (pdf) | ISBN 978–92–0–129922–2 (epub)

Subjects: LCSH: Heart — Imaging. | Heart — Diseases — Women. | Diagnostic imaging. | Radiology.

Classification: UDC 616.12:616 073 | STI/PUB/1970

FOREWORD

Cardiovascular disease is the leading cause of death worldwide, and although its prevalence was reduced in high income countries since the 2010s, the opposite has happened in low and middle income countries, where scarce financial resources make it even more difficult to address this health problem.

Sex-specific¹ data on cardiovascular disease are increasingly available; unfortunately such data are not collected on a regular basis, nor are they routinely applied in clinical practice.

Sex (or biological) differences in the cardiovascular system occur secondary to differences in gene expression on the sex chromosomes and are further influenced by sex-specific hormones, expressions and functions. These differences cause differences in the prevalence and type of cardiovascular diseases found in men and women. Women frequently present with atypical clinical features, which in addition to psychological and social factors, may lead to underdiagnosis or to their symptoms being considered non-cardiac by attending physicians and by the women themselves.

Moreover, the lack of awareness regarding the threat of cardiovascular disease in women leads to a lack of action with serious consequences, including millions of women not taking adequate preventive measures and not being appropriately treated according to clinical guidelines and the best evidence based medicine. For these reasons, proper diagnoses and prognoses to guide treatment are of crucial importance for women’s health. In this regard, cardiac imaging can be used in the framework of a multimodality approach by selecting the most appropriate test for an individual patient, with a focus on cost-effectiveness and socioeconomic circumstances.

This publication, which is aimed at health professionals, provides a critical review of the existing literature, covering sex-specific aspects of cardiovascular diseases in women such as epidemiology, specific risk factors and pathophysiology, as well as how to make a diagnosis and a prognosis of ischemic heart disease, both clinically and on the basis of cardiac images. In addition, reference is made to cardiotoxicity and radiotherapy induced disease in patients who have breast cancer, as well as to the current situation in low and middle income countries.

The technical officers responsible for this publication were D. Paez and M. Dondi of the Division of Human Health.

EDITORIAL NOTE

Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use.

This publication does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person.

Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States.

The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries.

The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA.

The IAEA has no responsibility for the persistence or accuracy of URLs for external or third party Internet web sites referred to in this book and does not guarantee that any content on such web sites is, or will remain, accurate or appropriate.

The authoritative version of this publication is the hard copy issued at the same time and available as pdf on www.iaea.org/publications. To create this version for e-readers, certain changes have been made, including a the movement of some figures and tables.

---

¹ ‘Gender’ is used to describe the characteristics of women and men that are socially constructed, while ‘sex’ refers to characteristics that are biologically determined. Both sex and gender differences contribute to women’s health and should be considered in the implementation of preventive strategies in the context of cardiovascular diseases.

CONTENTS

1. Introduction

1.1. Background

1.2. Objective

1.3. Scope

1.4. Structure

2. Ischemic heart disease in women

2.1. Traditional and female specific risk factors

2.2. Physiopathologic differences

2.3. Coronary disease

2.4. Obstructive CAD

3. Diagnosis of CAD and guidance to treatment

3.1. Non-obstructive CAD

3.2. Suggested diagnostic algorithm in women

4. Other clinical entities

4.1. Takotsubo cardiomyopathy

4.2. Sarcoidosis

4.3. Chronic inflammatory diseases

4.4. Breast cancer, cardiotoxicity and radiotherapy-induced disease

5. Situation in low and middle income countries

5.1. Primary prevention: risk factors control

5.2. Optimization of available resources

5.3. Role of research

REFERENCES

LIST OF ABBREVIATIONS

CONTRIBUTORS TO DRAFTING AND REVIEW

1. Introduction

1.1. Background

Although the prevalence of cardiovascular disease (CVD) has been reduced in high income countries during the decade since 2010, it remains the main cause of death worldwide. Among women, nearly one in three deaths is related to