Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease-state-of-the-evidence and clinical recommendations

• Type of Material: Article
• Authors: Viviany R. Taqueti, Brigham and Women’s Hospital; Sharmila Dorbala, Brigham and Women’s Hospital; David Wolinsky, Cleveland Clinic Florida; Brian Abbott, Brown University; Gary V. Heller, Morristown Medical Center; Timothy M. Bateman, University of Missouri; Jennifer H. Mieres, Hofstra Norwell School of Medicine; Lawrence M. Phillips, New York University; Nanette K Wenger, Emory University; Leslee J Shaw, Emory University
• Language: English
• Date: 2017-08-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, American Society of Nuclear Cardiology.
• Final Published Version (URL): http://dx.doi.org/10.1007/s12350-017-0926-8
• Title of Journal or Parent Work: Journal of Nuclear Cardiology
• ISSN: 1071-3581
• Volume: 24
• Issue: 4
• Start Page: 1402
• End Page: 1426
• Grant/Funding Information: This work was supported in part by K12 HD051959 Building Interdisciplinary Research Careers in Women’s Health and a Harvard Medical School Diversity Partnership Faculty Fellowship to Dr Taqueti.
• Keywords: Science & Technology; REDUCED RADIATION-EXPOSURE; Radiology, Nuclear Medicine & Medical Imaging; SYNDROME EVALUATION WISE; imaging; women; EFFECTIVE RISK STRATIFICATION; CORONARY-ARTERY-DISEASE; CARDIOVASCULAR MAGNETIC-RESONANCE; Stable ischemic heart disease; INCREMENTAL PROGNOSTIC VALUE; GENDER-RELATED DIFFERENCES; ASNC consensus statement; Cardiovascular System & Cardiology; APPROPRIATE USE CRITERIA; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; VENTRICULAR EJECTION FRACTION; EMISSION COMPUTED-TOMOGRAPHY
• Research Categories: Health Sciences, Radiology; Health Sciences, General

Abstract

This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Evidence is substantial that both SPECT and PET MPI effectively risk stratify women with SIHD. The addition of coronary flow reserve (CFR) with PET improves risk detection, including for women with nonobstructive coronary artery disease and coronary microvascular dysfunction. With the advent of PET with computed tomography (CT), multiparametric imaging approaches may enable integration of MPI and CFR with CT visualization of anatomical atherosclerotic plaque to uniquely identify at-risk women. Radiation dose-reduction strategies, including the use of ultra-low-dose protocols involving stress-only imaging, solid-state detector SPECT, and PET, should be uniformly applied whenever possible to all women undergoing MPI. Appropriate candidate selection for stress MPI and for post-MPI indications for guideline-directed medical therapy and/or invasive coronary angiography are discussed in this statement. The critical need for randomized and comparative trial data in female patients is also emphasized.