CARDIOVASCULAR multimodality imaging (MMI) in women requires specific consideration due to sex-related differences in cardiovascular diseases (CVD), highlighting the need for tailored diagnostic and therapeutic approaches.
CVD remains a leading cause of morbidity and mortality among women, with sex differences in risk factors, pathophysiology, and clinical outcomes increasingly recognised. Despite this, women are often under-represented in cardiovascular imaging studies, creating gaps in knowledge regarding optimal diagnostic and management strategies. A scientific statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology underscores the critical role of MMI in diagnosing and managing CVD in women while calling for further research to address these disparities. Factors such as pregnancy, menopause, and conditions like Takotsubo syndrome and spontaneous coronary artery dissection, which are more prevalent in women, underscore the necessity for sex-specific imaging approaches to ensure equitable care.
The review synthesises current evidence, highlighting how advanced MMI techniques, including echocardiography, cardiac MRI, CT, and nuclear imaging, contribute to diagnosis, risk stratification, and therapeutic monitoring in women. Findings reveal that hormonal factors, such as oestrogen, significantly influence disease development and progression, necessitating gender-sensitive applications of imaging modalities. However, substantial gaps remain in understanding sex-specific disease presentations and outcomes. For example, certain conditions like connective tissue disorders disproportionately affect women but lack sufficient targeted imaging protocols. Moreover, the integration of artificial intelligence in imaging presents a promising avenue but risks embedding sex bias due to historical under-representation of women in datasets.
This statement concludes that addressing sex disparities in cardiovascular imaging is vital to improving clinical practice and patient outcomes. Future research should prioritise balanced representation of sexes in clinical studies to refine diagnostic algorithms and enhance imaging accuracy for women. Additionally, incorporating sex-specific considerations into clinical guidelines is essential for equitable healthcare delivery. Advances in imaging technology and artificial intelligence hold significant promise, but their development must actively avoid perpetuating sex biases. By recognising sex as a critical determinant in cardiovascular health, clinicians can optimise preventative, diagnostic, and therapeutic pathways, fostering better outcomes for all patients.
Katrina Thornber, EMJ
Reference
Almeida A G et al. Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology. European Heart Journal-Cardiovascular Imaging. 2024;25(4):e116-e136.
