Sex Differences in Imaging for Structural Heart Disease: What is Normal for Women?

The accessibility of advanced imaging techniques has led to the exponential growth of transcatheter valve and structural interventions. The prevalence of valve disease in women is increasing in both developed and developing countries. Despite this increase in disease burden in women, optimal imaging indices for referral are understudied and underused in both research and clinical settings, resulting in later referral for intervention, suboptimal risk prediction and arbitrary procedural and device selection. Available published clinical trials are deficient in adequate sex-specific enrolment, resulting in a paucity of evidence to guide refined valve-related management in female patients. Thus, data referenced in current guidelines scarcely outline sex-specific recommendations with reference to optimal selection criteria, timing for referral and optimal procedural strategy and follow-up for this group of patients. This review summarises the available literature, focusing on disparities in imaging in women with valvular heart disease.