ARRS 2022 Abstracts

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E1890. Diagnosing Cardiac Ischemia in Women: Do We Need a New Approach?
Authors
  1. Rokas Liubauskas; Beth Israel Deaconess Medical Center
  2. Diana Litmanovich; Beth Israel Deaconess Medical Center
  3. Brian Jiang; Beth Israel Deaconess Medical Center
  4. Emily Larkin; Beth Israel Deaconess Medical Center
  5. Rachael Kirkbride; Royal Infirmary of Edinburgh
Background
Ischemic heart disease (IHD) is a leading cause of death in women, with a higher overall prevalence compared to men. Lack of awareness of this disease burden in women causes underdiagnosis of frequently atypical symptoms, suboptimal choice of diagnostic imaging modalities, delayed and less frequent percutaneous intervention/reperfusion, and suboptimal guideline-directed medical therapy – all contributing to higher female than male mortality. It is imperative for radiologists to be familiar with the unique considerations for optimal diagnostic imaging of women with suspected or known ischemic heart disease, including both appropriate imaging modalities and tailored imaging techniques. The purpose of this educational exhibit is to present the challenges for the detection of cardiac ischemia in women, examine the performance of noninvasive modalities in the detection of IHD, and highlight differential diagnoses such as nonischemic cardiomyopathies unique to or prevalent in women.

Educational Goals / Teaching Points
The goals of this exhibit are to review sex-based differences in cardiac anatomy and physiology relevant for imaging in women, including differences in heart rate, coronary arteries, and cardiac chambers size, increased frequency of microvascular disease, coronary spasm, and spontaneous coronary artery dissection. Female-specific diagnostic algorithms for the workup of suspected or known IHD, with discussion of appropriate testing modalities along with their strengths and weaknesses for imaging suspected IHD will be discussed. Special focus will be on nuclear medicine imaging, cardiac MRI, and coronary CTA. Lastly, female-specific imaging study preparation and protocol adjustments will be presented.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Sex-based differences in IHD include biology, pathophysiology, risk factor profiles, presentation, and symptoms. For known or suspected IHD (i.e., CCTA, CT-FFR) there are differences in image acquisition and application. Considerations for MINOCA (coronary microvascular spasm, Takotsubo syndrome, myocarditis, coronary embolism) include intravascular imaging, CMR, PET.

Conclusion
This presentation will help the radiologist understand the sex-specific differences in presentation, pathophysiology, and prognosis of IHD, thereby improving imaging modality selection, protocol adjustments, and interpretation of noninvasive testing in women.