Cardiac Imaging in Women: Use of Radionuclide Myocardial Perfusion Imaging and Echocardiography for Acute Chest Pain

Evidence for the value of noninvasive cardiac imaging in patients for the detection of ischemic heart disease has traditionally come from trials using male patients. The application of such technology for women is often presumptive. Because there is an overall lower prevalence of ischemic heart disease in women, difference in body habitus, and smaller heart size, cardiac imaging in women presents unique challenges for imaging specialists and cardiologists. With the introduction of technetium-99 meters perfusion agents, gated single-photon emission computed tomography, and attenuation correction, myocardial perfusion imaging (MPI) in women has achieved a high sensitivity and specificity for the detection of coronary artery disease similar to that observed in men. With harmonic imaging and myocardial contrast agents, two-dimensional echocardiography offers comparable diagnostic accuracy in women. More importantly, MPI and stress echocardiography have prognostic value in predicting future cardiovascular events. The severity and extent of the single-photon emission computed tomography myocardial perfusion defects independently predict future cardiovascular events. Myocardial perfusion rest imaging during acute chest pain has a 99% negative predictive value of subsequent cardiovascular events, and a positive study MPI is the most important predictor for future cardiac events. Both MPI and stress echocardiography can direct high-risk patients to more invasive management or selectively identify lower-risk patients, allowing safe discharge from the emergency department and unnecessary hospitalization. Using a triage approach incorporating MPI or rest echocardiography in patients with acute chest pain results in significant cost savings. However, data on rest imaging in women during acute chest pain are still lacking.