Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women
Background: Factors Affecting the Accuracy of NITs in Diagnosing CAD in Women
There are many factors that affect the accuracy of the noninvasive technologies (NITs) used to diagnose coronary artery disease (CAD) in women, making noninvasive CAD diagnosis challenging. Such factors include:
- Symptoms of CAD in women being less predictive and more atypical when compared with men
- Lower prevalence of obstructive epicardial CAD in women than in men
- Higher prevalence of single-vessel disease
- Smaller coronary artery size and left ventricular chamber size
- Lower tolerance for exercise testing due to comorbidities
CAD is diagnosed at an older age in women than in men. Women therefore have a higher prevalence of comorbidities such as obesity and diabetes at diagnosis, which limits their tolerance for exercise testing.
- Suboptimal response of the left ventricle to stress
- Hormonal effects of estrogens, which result in a digitalis-like false-positive echocardiographic response
- Female breast attenuation artifacts
- Poor left ventricular opacification on echocardiography
Keywords: background | coronary artery disease | CAD | women | diagnosis | noninvasive technologies | challenges
- Dolor RJ, Patel MR, Melloni C, et al. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Comparative Effectiveness Review No. 58 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10061-I). Rockville, MD: Agency for Healthcare Research and Quality; June 2012. AHRQ Publication No. 12-EHC034-EF. Available at www.effectivehealthcare.ahrq.gov/diagnosecad.cfm.
- Stangl V, Witzel V, Baumann G, et al. Current diagnostic concepts to detect coronary artery disease in women. Eur Heart J 2008;29(6):707-17. PMID: 18272503.
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