ARRS 2022 Abstracts


1916. Coronary CT Angiography: Is There a Gender Gap?
Authors * Denotes Presenting Author
  1. Rokas Liubauskas; Beth Israel Deaconess Medical Center
  2. Daniela Tridente *; Beth Israel Deaconess Medical Center
  3. Diana Litmanovich; Beth Israel Deaconess Medical Center
The leading cause of death worldwide in women is ischemic heart disease (IHD), with a higher overall prevalence than in men. Fundamental inequalities between the sexes regarding ischemic heart disease include lack of awareness of this disease burden in women, biological and pathophysiological differences, and variable risk factor profiles and presentation symptoms. All these factors lead to higher IHD prevalence and mortality rates in women than in men. Sex-based differences in cardiac anatomy and physiology are relevant for imaging in women, including differences in heart rate, coronary arteries size, common microvascular disease, coronary spasm, and propensity to tachycardia in response to stress. Those differences might require gender-tailored imaging techniques that are currently practiced scarcely, especially in coronary computed tomography angiography (CCTA) which is the imaging modality of choice for women presenting with suspected or known IHD. In this study, we aim to establish whether a gender gap in CCTA imaging exists, and if so, what are the most likely contributing factors.

Materials and Methods:
We conducted a single center IRB-approved retrospective pilot study of patients who underwent a CCTA over a period of 12 months. Diagnostic quality of CCTA was assessed and compared between men and women. Conditions of the scan were recorded (i.e., scanner type, prospective vs retrospective acquisition, radiation dose, heart rate). CAD-RADS and Agatston scores were recorded. Culprit factors potentially affecting the image quality were investigated - BMI, age, and ethnicity. The relationship between these factors and the image quality was assessed.

One hundred seventy-five patients included in the study (79, 45%, women). Median age was 60 years (SD 12, range 19-88 years). 64% (112/175) of scans were prospective. Median radiation dose was 540.16 (SD 278.8) mGy-cm. Median BMI was 28.3 kg/m2 (SD 6.43). Heart rate was adequate in 75% of the cases. Women had worse heart rate control (p=0.017), lower CAD-RADS scores (0.004), and higher Agatston scores (p=0.0039). Compared to men, women presented with significantly higher heart rates and required medical heart rate control more often, both of which correlated with worse imaging quality.

As we are entering the era of personalized screening, there is a critical need for implementation of gender specific strategies to improve outcomes, notably in the realm of cardiovascular disease. The results of our study could help identify better suited female-specific imaging study preparation and protocol adjustments to achieve optimal diagnostic imaging in CCTA.