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September 17, 2026Cardiovascular MedicineOpen Access

Mechanism-based framework integrates female-specific factors and coronary phenotyping to individualize IHD treatment in women.

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Population

Women with ischemic heart disease or ischemic symptoms, particularly those without flow-limiting epicardial…

Design

Review

Key result

A mechanism-based framework integrating female-specific biological factors and coronary phenotyping is proposed to support precise diagnosis and individualized treatment of IHD in women.

Authors

CTChiara TognolaRIRita Cristina Myriam IntravaiaGCGiulia Colombo

Discussion

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Overview

Clinicians should assess symptomatic women for microvascular dysfunction, vasospasm, and SCAD; extends evidence to support sex-specific IHD evaluation and management.

Key Points

  • To establish a clinically oriented, mechanism-based framework for diagnosing and managing ischemic heart disease in women presenting without obstructive epicardial stenosis.
  • Synthesized evidence on female-specific biological determinants across the life course, including hormonal transitions, vascular aging, and pregnancy-related cardiovascular risk enhancers.
  • Evaluated the diagnostic utility of multimodality imaging, intracoronary imaging, and invasive coronary functional testing to phenotype distinct causes of myocardial ischemia.
  • Identified microvascular dysfunction, vasospasm, diffuse atherosclerosis, and spontaneous coronary artery dissection as leading non-obstructive drivers of ischemia in symptomatic women.
  • Outlined an integrated care strategy combining standard cardiovascular prevention, mechanism-targeted antianginal therapies, and specialized reproductive, pregnancy, and psychosocial considerations.

Structured PICO

P
Population
Women with ischemic heart disease (IHD) or ischemic symptoms, particularly those without flow-limiting epicardial stenosis
I
Intervention
A clinically oriented, mechanism-based framework integrating multimodality imaging, invasive coronary functional testing, and intracoronary imaging for diagnosis and management

Proposes a clinically oriented, mechanism-based framework for diagnosing and managing ischemic heart disease in women, emphasizing non-obstructive causes such as microvascular dysfunction, vasospasm, and SCAD.

Limitations

  • The proposed framework is a practical synthesis rather than a validated classification system.

Cite This Study

Tognola et al. (2026) conducted a review in Ischemic heart disease in women. A mechanism-based framework integrating female-specific biological factors and coronary phenotyping is proposed to support precise diagnosis and individualized treatment of IHD in women.

synapsesocial.com/papers/6aabb6f95f706d05830e5c43https://doi.org/10.3390/cardiovascmed29030033
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