The Role of Cardiac CT in Women Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology The Role of Cardiac CT in Women Shinie Kuo, M.D., Kavitha M. Chinnaiyan, M.D., FACC, FSCCT Beaumont Health System, Royal Oak, MI Institution Picture/Logo Optional Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND Discrepancy between symptoms and disease prevalence is a significant challenge in diagnosis of CAD in women. Fewer than half of the women that undergo invasive coronary angiography (ICA) have obstructive CAD despite high symptom burden. Nearly one in four women with nonobstructive CAD experience a nonfatal cardiovascular event over the subsequent three years. Commonly used noninvasive tests are less accurate in women. By virtue of its ability to visualize the coronary arteries directly, cardiac CT may be an attractive diagnostic option in women. Copyright American Society of Nuclear Cardiology

Cardiac CT in Asymptomatic Women Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Cardiac CT in Asymptomatic Women Calcium scoring cardiac CT is shown to overcome the discrepancy between risk assessment and clinical presentation. In 3601 “low risk” women in the Multi-Ethnic Study of Atherosclerosis (MESA), those with any detectable coronary calcium were at increased risk for CAD compared to those with a CAC of zero. CAC is the strongest predictor of death with the most consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve of 0.71 vs. 0.64, p <0.001) regardless of age and sex over long-term follow-up. Having a CAC of zero with high clinical risk confers a better prognosis than having low-to-intermediate risk with any CAC. CAC can aid in reclassification of risk in women, with important prognostic implications. Copyright American Society of Nuclear Cardiology

Coronary CT Angiography in Women Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Coronary CT Angiography in Women Although the accuracy of coronary CTA is comparable between men and women, its sensitivity to detect stenosis in distal coronary segments and side branches appears to be lower in women. Copyright American Society of Nuclear Cardiology

Coronary CTA in Women – Unique Considerations Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Coronary CTA in Women – Unique Considerations A large number of women have evidence of ischemia on stress testing, now thought to be mediated by coronary endothelial and microvascular dysfunction. Although this syndrome was previously considered to be benign, major adverse cardiac outcomes in women with nonobstructive CAD are three times more common than in men. This dilemma lends itself to the particular challenge of using ICA as the gold standard for diagnosis in women, with the lack of a “normal” reference segment due to the absence of a focal epicardial stenosis. Compared to ICA, coronary CTA may be better suited for evaluation of symptomatic women with low-risk findings on stress testing by virtue of its ability to visualize the lumen as well as the arterial walls. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS Nonobstructive disease, which is of particular concern in women, is more readily diagnosed with CTA with demonstrated implications for prognosis. Large gaps continue to exist in defining the optimal diagnostic approaches for endothelial and microvascular function that seem to play important roles in in women. Diagnostic approaches aimed toward these pathophysiological mechanisms would ideally lead to a paradigm shift in the diagnosis and treatment of CAD in women that is not focused on finding flow-limiting stenosis. Copyright American Society of Nuclear Cardiology