The role of nuclear cardiology in the diagnosis and risk stratification of women with ischemic heart disease

Ischemic heart disease (IHD) is the leading cause of death in women. Women present with coronary artery disease later in life than men, with greater number of risk factors and higher rate of angina. Women have higher mortality compared with age-matched men despite having less anatomical coronary artery disease. Distinct pathophysiologies are thought to account for sex-related differences in the presentation and prognosis of IHD. More women than men have chest pain secondary to coronary reactivity, microvascular dysfunction, and plaque erosion with distal microembolization. Sex-related factors such as lower exercise capacity, less specific ST-segment electrocardiographic changes, smaller left ventricular size, and breast attenuation can complicate the diagnosis of IHD in women. These sex-specific factors should be considered before determining the appropriate test to be performed in a woman with suspected IHD. Technological advances in nuclear cardiology including attenuation correction and coronary flow reserve measurement by PET hold promise in optimizing the diagnosis and risk stratification of women with IHD.