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Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISE PowerPoint Presentation
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Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010. Symptoms and coronary artery disease diagnosis: the preminent role of imaging techniques. FEDERICA ETTORI SPEDALI CIVILI EMODINAMICA BRESCIA.

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Tenth International Symposium

HEART FAILURE & Co.

CARDIOLOGY SCIENCE UPDATE

FEMALE DOCTORS SPEAKING

ON FEMALE DISEASES

Milano

9 - 10 aprile 2010

Symptoms and coronary artery disease diagnosis:the preminent role of imaging techniques

FEDERICA ETTORI

SPEDALI CIVILI EMODINAMICA BRESCIA

men women symptoms
MEN / WOMEN : SYMPTOMS
  • DYSPNEA =
  • CHEST PAIN
  • LEFT ARM PAIN
  • DIAPHORESIS
  • NAUSEA
  • DIAPHORESIS
  • NAUSEA

= M

= F

AFTER BINARY LOGISTIC REGRESSION

ACS REGISTRY MICHIGAN

AJC 2006

myocardial perfusion image appropriateness
MYOCARDIAL PERFUSION IMAGE: APPROPRIATENESS

SPECT : 6315 PTS INAPPROPRIATE USE = 14,4%

HENDEL JACC 2010

exercise ecg diagnosis
Exercise ECG : diagnosis
  • Exerctional symptoms of low predictable value
  • Shorter exercise duration
  • Lower CAD prevalence
  • Reported high rate of false positives
  • Heart rate recovery
  • Functional capacity
  • Integrative test scores
stress echocardiography in women diagnosis
Stress echocardiography in womenDiagnosis
  • No ionization radiation
  • Systolic and diastolic Ventricular dysfunction
  • Valvular disease
  • Extent of infarction and stress induced ischemia
  • Minimal added cost
  • More cost effective than exercise ECG
  • Exercise test or pharmacological test
  • Reduced image quality (obese,smokers)

NO SEX EFFECT

risk assessment 5yr survival 4234 women exercise and dobutamine stress
RISK ASSESSMENT 5yr survival 4234 womenexercise and dobutamine stress

Shaw EUR HEART J 2005

cardiac radionuclide imaging
CARDIAC RADIONUCLIDE IMAGING
  • Perfusion defect
  • Global and regional left ventricular function
  • Left ventricular volumes
  • Lung uptake of 201 Tl
  • Exercise test or pharmacological test
stress spect risk assessment
STRESS SPECT RISK ASSESSMENT

Continuum of risk

MARWICK AJM 1999

ct coronary calcification diagnosis
CT CORONARY CALCIFICATION DIAGNOSIS
  • NEGATIVE PREDICTIVE VALUE = 100%
  • LOW SPECIFICITY (Modest relationship between CAC and obstructive coronary artery disease)

AHA STATEMENT IN NON INVASIVE TESTING (2005 )

“Coronary artery calcium testing for CAD risk detection should be limitated to clinically selected women at intermediate risk”

magnetic resonance myocardial perfusion imaging meta analysis
Magnetic resonancemyocardial perfusion imagingMETA- ANALYSIS
  • PI = DYNAMIC FIRST-PASS PERFUSION IMAGING
  • IWMA = STRESS INDUCED WALL MOTION ABNORMALITIES IMAGINES
  • SENSITIVITY=91%
  • SPECIFICITY=81%

X

X

ACC 2006

THE STRESS MRI IS INDICATED

IN SYMPTOMATIC PATIENTS

WITH INTERMEDIATE

PRETEST PROBABILITY

NANDALUM JACC 2007

computed tomography angiography
COMPUTED TOMOGRAPHY ANGIOGRAPHY

PROMISE trial ongoing

Anatomic Functional

Strategy test

CTA strategy

  • CAD SEVERITY
  • TOTAL PLAQUE SCORE
  • LVEF

CHOW JACC 2010

?

clinical reason for symptoms alternative hypothesis
Non obstructive atherosclerosis

Endotelial dysfunction

Microvascular disease and Subendocardial ischemia

PLAQUE MORPHOLOGY

Carotid IMT

ACETYCHOLINE TEST

CORONARY FLOW RESERVE

IVUS - OCT - CT

Clinical reason for symptomsalternative hypothesis
role of non invasive testing in the clinical evaluation of women with suspected cad
Role of non invasive testing in the clinical evaluation of women with suspected CAD

Asymptomatic women

  • Low risk in premenopausal women except
  • High risk : diabetes, periferal arterial disease, chronic kidney disease
  • Framingham risk score intermediate (controversial recommendation)