non invasive diagnosis of Coronary Heart Disease in Women

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non invasive diagnosis of Coronary Heart Disease in Women
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a number of problems in the diagnostic evaluation of CHD in women:

• The diagnostic workup of women may be limited or prematurely terminated due to clinical misperception of a lower pretest coronary heart disease probability (by the physician and/or the patient).

• There is a paucity of validated gender-neutral testing procedures with equivalent diagnostic accuracies in men and women.

• Gender-based discrepancies exist in the availability, use, and accuracy of existing diagnostic studies. In a population-based study in Olmsted County, Minnesota, the utilization rate ratio for exercise testing in men versus women was 2.7, a finding that was similar in all age groups [2]. At the time of the initial exercise test, women were more symptomatic and had a poorer exercise performance than men.

• Previous problems in the diagnostic techniques for the evaluation of CHD in women may have contributed to a lack of physician confidence and the underuse of available testing procedures.

This underestimation of clinical coronary risk in women, and the limited diagnostic accuracy of some noninvasive CHD testing procedures, has contributed to the negative outcomes which have been documented in women after an acute myocardial infarction [3,4] or coronary bypass [5,6], and in other high-risk clinical subsets (eg, congestive heart failure and diabetes) [7]. Women with heart disease are also frequently characterized by a greater number of comorbid medical conditions, coronary risk factors [8], and functional limitations [9], in part because they develop heart disease at a more advanced age than men. (See "Diagnosis and management of coronary heart disease in women"). The net result has been a female CHD population with excessively high morbidity and morality.

This card will review the accuracy of various existing noninvasive diagnostic techniques in women, and discuss the advantages (and potential limitations) of novel diagnostic imaging strategies. Based upon these data, we propose an algorithm for the clinically-directed, noninvasive diagnosis of CHD in women.

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