Cardiovascular Imaging for Ischemic Heart Disease in Women
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The following are key points to remember from this state-of-the-art review of cardiovascular imaging for ischemic heart disease in women:

1. Women have a unique phenotype of ischemic heart disease characterized by fewer calcific lesions, more nonobstructive plaques, and higher prevalence of microvascular disease.
2. In low-intermediate risk women who can exercise and have a normal resting electrocardiogram (ECG), exercise treadmill testing (ETT) is recommended.
3. The addition of imaging to exercise is recommended for intermediate-risk women who have an abnormal baseline ECG. Stress echocardiography does not use radiation and may be a preferred choice for younger women.
4. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging has sex-specific challenges in women due to the heart being smaller than men and potentially resulting in a lower sensitivity to detect obstructive coronary artery disease caused by the low resolution of conventional gamma cameras.
5. Coronary computed tomographic angiography has high diagnostic accuracy in detecting atherosclerotic plaque and assessing plaque characteristics.
6. Coronary artery calcium (CAC) scoring is effective for risk stratification in asymptomatic patients. Women have fewer calcified lesions, fewer calcified vessels, and lower CAC volumes; nevertheless, a score of 0 carries a similar low risk of cardiovascular disease events for both men and women.