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Published in: Current Cardiology Reports 2/2010

Open Access 01-03-2010

Noninvasive Assessment of Coronary Artery Disease in Women: What’s Next?

Authors: Lawrence M. Phillips, Jennifer H. Mieres

Published in: Current Cardiology Reports | Issue 2/2010

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Abstract

Significant progress in research has been made in the areas of sex-specific aspects of cardiovascular disease. Despite these advances, coronary artery disease (CAD) is the leading cause of death of women in the Western world. Over the past decade, the focused research on women at risk for ischemic heart disease has helped to clarify our understanding of some of the sex-specific factors, which are important in detecting CAD. In women, the detection and evaluation of physiologically significant CAD is challenging, especially given that traditional tests designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients who have a lower prevalence of obstructive coronary disease, greater burden of symptoms, and a high atherosclerotic burden. In this article, we review the available evidence on the role of contemporary cardiovascular imaging techniques in evaluating ischemic heart disease in women.
Literature
2.
go back to reference Ford ES, Ajani UA, Croft JB, et al.: Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007, 356:2388–2398.CrossRefPubMed Ford ES, Ajani UA, Croft JB, et al.: Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007, 356:2388–2398.CrossRefPubMed
3.
go back to reference Mosca L, Banka CL, Benjamin EJ, et al.: Evidence-based guidelines for cardiovascular disease prevention in women: 2007 Update. J Am Coll Cardiol 2007, 49:1230–1250.CrossRefPubMed Mosca L, Banka CL, Benjamin EJ, et al.: Evidence-based guidelines for cardiovascular disease prevention in women: 2007 Update. J Am Coll Cardiol 2007, 49:1230–1250.CrossRefPubMed
4.
go back to reference Lloyd-Jones D, Adams R, Carnethon M, et al.: Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119:480–486.CrossRefPubMed Lloyd-Jones D, Adams R, Carnethon M, et al.: Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119:480–486.CrossRefPubMed
5.
go back to reference Murphy SL: Death: Final data for 1998. Natl Vital Stat Rep 2000, 48:1–105.PubMed Murphy SL: Death: Final data for 1998. Natl Vital Stat Rep 2000, 48:1–105.PubMed
6.
go back to reference Shaw LJ, Bairey Merz CN, Pepine CJ, et al.: Insights From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study. Part 1: gender differences in traditional an novel risk factors, symptom evaluation and gender optimized diagnostic strategies. J Am Coll Cardiol 2006, 47:4S–20S. Shaw LJ, Bairey Merz CN, Pepine CJ, et al.: Insights From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study. Part 1: gender differences in traditional an novel risk factors, symptom evaluation and gender optimized diagnostic strategies. J Am Coll Cardiol 2006, 47:4S–20S.
7.
go back to reference Mieres JH, Shaw LJ, Arai A, et al.: Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005, 111:682–696.CrossRefPubMed Mieres JH, Shaw LJ, Arai A, et al.: Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation 2005, 111:682–696.CrossRefPubMed
8.
go back to reference Bairey Merz CN, Shaw LJ, Reis SE, et al.: Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 2006, 47(3 Suppl):S21–S29. Bairey Merz CN, Shaw LJ, Reis SE, et al.: Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 2006, 47(3 Suppl):S21–S29.
9.
go back to reference Shaw LJ, Bugiardini R, Bairey Merz CN: Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 2009, 54:1561–1575. In this state-of-the-art paper, the authors discuss the spectrum of etiologies involved in IHD in women. Dysfunction of the microvasculature is implicated as a cause of symptoms and worse prognosis in the absence of obstructive disease. An additional leading culprit is abnormal reactivity in the small heart arteries leading to poor blood flow (ischemia) to the heart muscle CrossRefPubMed Shaw LJ, Bugiardini R, Bairey Merz CN: Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 2009, 54:1561–1575. In this state-of-the-art paper, the authors discuss the spectrum of etiologies involved in IHD in women. Dysfunction of the microvasculature is implicated as a cause of symptoms and worse prognosis in the absence of obstructive disease. An additional leading culprit is abnormal reactivity in the small heart arteries leading to poor blood flow (ischemia) to the heart muscle CrossRefPubMed
10.
go back to reference •• Gulati M, Cooper-DeHoff RM, McClure C, et al.: Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med 2009, 169:843–850. This study reports on cardiovascular events (MI, death, stroke, heart failure) between the symptomatic cohort of women from the WISE study and the asymptomatic cohort of women from the St. James WTH Project. Women with symptoms and signs suggestive of ischemia but without obstructive CAD are at elevated risk for cardiovascular events compared with asymptomatic community-based women.CrossRefPubMed •• Gulati M, Cooper-DeHoff RM, McClure C, et al.: Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med 2009, 169:843–850. This study reports on cardiovascular events (MI, death, stroke, heart failure) between the symptomatic cohort of women from the WISE study and the asymptomatic cohort of women from the St. James WTH Project. Women with symptoms and signs suggestive of ischemia but without obstructive CAD are at elevated risk for cardiovascular events compared with asymptomatic community-based women.CrossRefPubMed
12.
go back to reference Kwok YS, Kim C, Grady D, et al.: Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol 1999, 83:660–666.CrossRefPubMed Kwok YS, Kim C, Grady D, et al.: Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol 1999, 83:660–666.CrossRefPubMed
13.
go back to reference Alexander KP, Shaw LJ, Shaw LK, et al.: Value of exercise treadmill testing in women. J Am Coll Cardiol 1998, 32:1657–1664. (Published erratum appears in J Am Coll Cardiol 1999, 33:289.) Alexander KP, Shaw LJ, Shaw LK, et al.: Value of exercise treadmill testing in women. J Am Coll Cardiol 1998, 32:1657–1664. (Published erratum appears in J Am Coll Cardiol 1999, 33:289.)
14.
go back to reference Gulati M, Pandey DK, Arnsdorf MF, et al.: Exercise capacity and the risk of death in women: the St. James Women Take Heart Project. Circulation 2003, 108:1554–1559.CrossRefPubMed Gulati M, Pandey DK, Arnsdorf MF, et al.: Exercise capacity and the risk of death in women: the St. James Women Take Heart Project. Circulation 2003, 108:1554–1559.CrossRefPubMed
15.
go back to reference Mora S, Redberg RF, Cui Y, et al.: Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women. JAMA 2003, 290:1600–1607.CrossRefPubMed Mora S, Redberg RF, Cui Y, et al.: Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women. JAMA 2003, 290:1600–1607.CrossRefPubMed
16.
go back to reference Gulati M, Black HR, Shaw LJ, et al.: The prognostic value of a nomogram for exercise capacity in women. N Engl J Med 2005, 353:468–475.CrossRefPubMed Gulati M, Black HR, Shaw LJ, et al.: The prognostic value of a nomogram for exercise capacity in women. N Engl J Med 2005, 353:468–475.CrossRefPubMed
17.
go back to reference Shaw LJ, Olson MB, Kip K, et al.: The value of estimated functional capacity in estimating outcome. J Am Coll Cardiol 2006, 47:36S–43S.CrossRef Shaw LJ, Olson MB, Kip K, et al.: The value of estimated functional capacity in estimating outcome. J Am Coll Cardiol 2006, 47:36S–43S.CrossRef
18.
go back to reference Cheitlin MD, Armstrong WF, Aurigemma GP, et al.: ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol 2003, 42:954–970.CrossRefPubMed Cheitlin MD, Armstrong WF, Aurigemma GP, et al.: ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol 2003, 42:954–970.CrossRefPubMed
19.
go back to reference Williams MJ, Marwick TH, O’Gorman D, et al.: Comparison of exercise echocardiography with an exercise score to diagnose coronary artery disease in women. Am J Cardiol 1994, 74:435–438.CrossRefPubMed Williams MJ, Marwick TH, O’Gorman D, et al.: Comparison of exercise echocardiography with an exercise score to diagnose coronary artery disease in women. Am J Cardiol 1994, 74:435–438.CrossRefPubMed
20.
go back to reference Arruda-Olson AM, Jracan EM, Mahoney DW, et al.: Prognostic value of exercise echocardiography in 5,978 patients: is there a gender difference? J Am Coll Cardiol 2002, 39:625–631.CrossRefPubMed Arruda-Olson AM, Jracan EM, Mahoney DW, et al.: Prognostic value of exercise echocardiography in 5,978 patients: is there a gender difference? J Am Coll Cardiol 2002, 39:625–631.CrossRefPubMed
21.
go back to reference Shaw LJ, Vassey C, Sawada S, et al.: Impact of gender on risk stratification by exercise and dobutamine stress echocardiography: long-term mortality in 4,234 women and 6,898 men. Eur Heart J 2005, 26:447–456.CrossRefPubMed Shaw LJ, Vassey C, Sawada S, et al.: Impact of gender on risk stratification by exercise and dobutamine stress echocardiography: long-term mortality in 4,234 women and 6,898 men. Eur Heart J 2005, 26:447–456.CrossRefPubMed
22.
go back to reference Metz LD, Beattie M, Hom R, et al.: The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol 2007, 49:227–237.CrossRefPubMed Metz LD, Beattie M, Hom R, et al.: The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol 2007, 49:227–237.CrossRefPubMed
23.
go back to reference Klocke FJ, Baird MG, Lorell BH, et al.: ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines of the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003, 108:1404–1418.CrossRefPubMed Klocke FJ, Baird MG, Lorell BH, et al.: ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: a report of the American College of Cardiology/American heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines of the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003, 108:1404–1418.CrossRefPubMed
24.
go back to reference Mieres JH, Shaw LJ, Hendel RC, et al.: American Society of Nuclear Cardiology consensus statement: Task Force on Women and Coronary Artery Disease—the role of myocardial perfusion imaging in the clinical evaluation of coronary artery disease in women. J Nucl Cardiol 2003, 10:95–101.CrossRefPubMed Mieres JH, Shaw LJ, Hendel RC, et al.: American Society of Nuclear Cardiology consensus statement: Task Force on Women and Coronary Artery Disease—the role of myocardial perfusion imaging in the clinical evaluation of coronary artery disease in women. J Nucl Cardiol 2003, 10:95–101.CrossRefPubMed
25.
go back to reference Hansen CL, Crabbe D, Rubin S: Lower diagnostic accuracy of thallium-201 SPECT myocardial perfusion imaging in women: an effect of smaller chamber size. J Am Coll Cardiol 1996, 28:1214–1219.CrossRefPubMed Hansen CL, Crabbe D, Rubin S: Lower diagnostic accuracy of thallium-201 SPECT myocardial perfusion imaging in women: an effect of smaller chamber size. J Am Coll Cardiol 1996, 28:1214–1219.CrossRefPubMed
26.
go back to reference Taillefer R, DePuey EG, Udelson JE, et al.: Comparative diagnostic accuracy of Tl-201 and Tc-99 m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997, 29:69–77.CrossRefPubMed Taillefer R, DePuey EG, Udelson JE, et al.: Comparative diagnostic accuracy of Tl-201 and Tc-99 m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997, 29:69–77.CrossRefPubMed
27.
go back to reference Santana-Boado C, Candell-Rivera J, Castell-Conesa J, et al.: Diagnostic accuracy of technetium-99 m-MIBI myocardial SPECT in women and men. J Nucl Med 1998, 39:751–755.PubMed Santana-Boado C, Candell-Rivera J, Castell-Conesa J, et al.: Diagnostic accuracy of technetium-99 m-MIBI myocardial SPECT in women and men. J Nucl Med 1998, 39:751–755.PubMed
28.
go back to reference Mieres JH, Makaryus AN, Cacciabaudo JM, et al.: Value of electrocardiographically gated single-photon emission computed tomographic myocardial perfusion scintigraphy in a cohort of symptomatic postmenopausal women. Am J Cardiol 2007, 99:1096–1099.CrossRefPubMed Mieres JH, Makaryus AN, Cacciabaudo JM, et al.: Value of electrocardiographically gated single-photon emission computed tomographic myocardial perfusion scintigraphy in a cohort of symptomatic postmenopausal women. Am J Cardiol 2007, 99:1096–1099.CrossRefPubMed
29.
go back to reference Elhendy A, Schinkel AF, Bax JJ, et al.: Accuracy of stress Tc-99 m tetrofosmin myocardial perfusion tomography for the diagnosis and localization of coronary artery disease in women. J Nucl Cardiol 2006, 13:629–634.CrossRefPubMed Elhendy A, Schinkel AF, Bax JJ, et al.: Accuracy of stress Tc-99 m tetrofosmin myocardial perfusion tomography for the diagnosis and localization of coronary artery disease in women. J Nucl Cardiol 2006, 13:629–634.CrossRefPubMed
30.
go back to reference Amanullah AM, Berman DS, Hachamovitch R, et al.: Identification of severe or extensive coronary artery disease in women by adenosine technetium-99 m sestamibi SPECT. Am J Cardiol 1997, 80:132–137.CrossRefPubMed Amanullah AM, Berman DS, Hachamovitch R, et al.: Identification of severe or extensive coronary artery disease in women by adenosine technetium-99 m sestamibi SPECT. Am J Cardiol 1997, 80:132–137.CrossRefPubMed
31.
go back to reference Marwick TH, Shaw LJ, Lauer MS, et al.: The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease. Economics of Noninvasive Diagnosis (END) Study Group. Am J Med 1999, 106:172–178.CrossRefPubMed Marwick TH, Shaw LJ, Lauer MS, et al.: The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease. Economics of Noninvasive Diagnosis (END) Study Group. Am J Med 1999, 106:172–178.CrossRefPubMed
32.
33.
go back to reference Berman DS, Kang X, Hayes SW, et al.: Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management. J Am Coll Cardiol 2003, 41:1125–1133CrossRefPubMed Berman DS, Kang X, Hayes SW, et al.: Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management. J Am Coll Cardiol 2003, 41:1125–1133CrossRefPubMed
34.
go back to reference •• Bellasi A, Raggi P, Merz CN, Shaw LJ: New insights into ischemic heart disease in women. Cleve Clin J Med 2007, 74:585–594. This paper discusses the recent evidence on sex differences in CAD and possible strategies for detecting and assessing coronary disease in women.CrossRefPubMed •• Bellasi A, Raggi P, Merz CN, Shaw LJ: New insights into ischemic heart disease in women. Cleve Clin J Med 2007, 74:585–594. This paper discusses the recent evidence on sex differences in CAD and possible strategies for detecting and assessing coronary disease in women.CrossRefPubMed
35.
go back to reference Di Carli MF, Hachamovitch R: New technology for noninvasive evaluation of coronary artery disease. Circulation 2007, 115:1464–1480.CrossRefPubMed Di Carli MF, Hachamovitch R: New technology for noninvasive evaluation of coronary artery disease. Circulation 2007, 115:1464–1480.CrossRefPubMed
36.
go back to reference Heller GV, Calnon D, Dorbala S: Recent advances in cardiac PET and PET/CT myocardial perfusion imaging. J Nucl Cardiol 2009, 16:962–969.CrossRefPubMed Heller GV, Calnon D, Dorbala S: Recent advances in cardiac PET and PET/CT myocardial perfusion imaging. J Nucl Cardiol 2009, 16:962–969.CrossRefPubMed
37.
go back to reference Dorbala S, Vangala D, Samson U, et al.: Value of vasodilator left ventricular ejection fraction reserve in evaluation of the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: a 82 Rb PET/CT study. J Nucl Med 2007, 48:349–358.PubMed Dorbala S, Vangala D, Samson U, et al.: Value of vasodilator left ventricular ejection fraction reserve in evaluation of the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: a 82 Rb PET/CT study. J Nucl Med 2007, 48:349–358.PubMed
38.
go back to reference Dorbala S, Hachamovitch R, Curillova Z, et al.: Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging 2009, 2:846–854.CrossRefPubMed Dorbala S, Hachamovitch R, Curillova Z, et al.: Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging 2009, 2:846–854.CrossRefPubMed
39.
go back to reference Herzog BA, Husmann L, Valenta I, et al.: Long-term prognostic value of 13 N-ammonia myocardial perfusion Positron emission tomography added value of coronary flow reserve. JACC Cardiovasc Imaging 2009, 54:150–156. Herzog BA, Husmann L, Valenta I, et al.: Long-term prognostic value of 13 N-ammonia myocardial perfusion Positron emission tomography added value of coronary flow reserve. JACC Cardiovasc Imaging 2009, 54:150–156.
40.
go back to reference de Vries J, DeJongste MJ, Jessurun GA, et al.: Myocardial perfusion quantification in patients suspected of cardiac syndrome X with positive and negative exercise testing: a [13-N] ammonia positron emission tomography study. Nucl Med Commun 2006, 27:791–794.CrossRefPubMed de Vries J, DeJongste MJ, Jessurun GA, et al.: Myocardial perfusion quantification in patients suspected of cardiac syndrome X with positive and negative exercise testing: a [13-N] ammonia positron emission tomography study. Nucl Med Commun 2006, 27:791–794.CrossRefPubMed
41.
go back to reference Raggi P, Shaw LJ, Berman DS, Callister TQ: Gender-based differences in the prognostic value of coronary calcification. J Womens Health (Larchmt) 2004, 13:273–283.CrossRef Raggi P, Shaw LJ, Berman DS, Callister TQ: Gender-based differences in the prognostic value of coronary calcification. J Womens Health (Larchmt) 2004, 13:273–283.CrossRef
42.
go back to reference Budoff MJ, Achenbach S, Blumenthal RS, et al.: Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006, 114:1761–1791.CrossRefPubMed Budoff MJ, Achenbach S, Blumenthal RS, et al.: Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 2006, 114:1761–1791.CrossRefPubMed
43.
go back to reference Greenland P, Bonow RO, Brundage BH, et al.: ACCF/AHA 2007 clinical expert consensus document on CAC scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2007, 49:378–402.CrossRefPubMed Greenland P, Bonow RO, Brundage BH, et al.: ACCF/AHA 2007 clinical expert consensus document on CAC scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2007, 49:378–402.CrossRefPubMed
44.
go back to reference Pundziute G, Schuijf JD, Jukema JW, et al.: Gender influence on the diagnostic accuracy of 64-slice multislice computed tomography coronary angiography for detection of obstructive coronary artery disease. Heart 2008, 94:48–52.CrossRefPubMed Pundziute G, Schuijf JD, Jukema JW, et al.: Gender influence on the diagnostic accuracy of 64-slice multislice computed tomography coronary angiography for detection of obstructive coronary artery disease. Heart 2008, 94:48–52.CrossRefPubMed
45.
go back to reference Pflederer T, Rudofsky L, Ropers D, et al.: Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenol 2009, 192:1045–1050.CrossRefPubMed Pflederer T, Rudofsky L, Ropers D, et al.: Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenol 2009, 192:1045–1050.CrossRefPubMed
46.
go back to reference Panting JR, Gatehouse PD, Yang GZ, et al.: Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 2002, 346:1948–1953.CrossRefPubMed Panting JR, Gatehouse PD, Yang GZ, et al.: Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 2002, 346:1948–1953.CrossRefPubMed
47.
go back to reference Gebker R, Jahnke C, Hucko T, et al.: Dobutamine stress magnetic resonance imaging for the detection of coronary artery disease in women. Heart 2009 August 16 (Epub ahead of print). Gebker R, Jahnke C, Hucko T, et al.: Dobutamine stress magnetic resonance imaging for the detection of coronary artery disease in women. Heart 2009 August 16 (Epub ahead of print).
48.
go back to reference Wallace EL, Morgan TM, Walsh TF, et al.: Dobutamine cardiac magnetic resonance results, predict cardiac prognosis in women with known or suspected ischemic heart disease. JACC Cardiovasc Imaging 2009, 2:299–307.CrossRefPubMed Wallace EL, Morgan TM, Walsh TF, et al.: Dobutamine cardiac magnetic resonance results, predict cardiac prognosis in women with known or suspected ischemic heart disease. JACC Cardiovasc Imaging 2009, 2:299–307.CrossRefPubMed
Metadata
Title
Noninvasive Assessment of Coronary Artery Disease in Women: What’s Next?
Authors
Lawrence M. Phillips
Jennifer H. Mieres
Publication date
01-03-2010
Publisher
Current Science Inc.
Published in
Current Cardiology Reports / Issue 2/2010
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-010-0084-y

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