Jay Pham;
Virginia Commonwealth University Health Systems
Shaimaa Fadl;
Virginia Commonwealth University Health Systems
Jonathan Revels;
NYU Langone Radiology Associates
John Grizzard;
Virginia Commonwealth University Health Systems
Background
Cardiovascular disease (CVD) is the leading cause of death in both men and women; however, women may have sex-specific presentation (atypical symptoms) and disease occurrence that create unique diagnostic considerations have a direct impact on prognosis. Sex-specific cardiovascular magnetic resonance (CMR) findings are found in ischemic (IHD), nonischemic, and hereditary cardiomyopathy (CM). CMR is a robust and nonionizing tool that is able to provide assessment of both cardiac anatomy and function. Nonionizing radiation exposure becomes an important concept because a subset of female patients are premenopausal and or child-bearing age. CMR also provides value in IHD because women are at higher risk of morbidity and mortality despite lower burden of obstructive coronary artery disease. Lastly, there may be utility of CMR in assessment of cardiometabolic changes in transgender patients undergoing hormone therapy, although research remains limited.
Educational Goals / Teaching Points
After reviewing this exhibit, participants should be able to 1. discuss the gender-specific presentation in cardiomyopathies, 2. discuss the CMR findings for cardiomyopathies in women, in particular, myocardial infarction without obstructive CAD (MINOCA), peripartum CMs, Stress/Takotsubo CM, rheumatic/cancer-related CMs, and hereditary CMs, and 3. understand management and prognosis of aforementioned CMs.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The presence and distribution of late gadolinium enhancement (LGE) along with LV/RV morphology, dynamic wall motion abnormality, and T1 and T2 mapping helps differentiate between different CMs. For example, in MINOCA, LGE may be subendocardial and have a vascular distribution. Other examples include LV systolic akinesis with ballooning in stress CM, dilated LV in peripartum CM, and focal mid-myocardial LGE in basal inferior segment of LV in systemic Lupus. A representative hereditary CM is Fabry disease, where there is LGE in the basal inferolateral midwall, LV hypertrophy, low native T1 signal and elevated T2 signal.
Conclusion
It is important to recognize the gender-specific presentation and imaging features of multiple etiologies of CMs in women because of the diagnostic and prognostic impact.
