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Rofo 2023; 195(04): 309-318
DOI: 10.1055/a-1966-0039
Review

Cardiovascular Disease in Women: What the Radiologist Needs to Know

Kardiovaskuläre Erkrankungen: Was die Radiologin und der Radiologe wissen müssen
Oliver Josef Sommer 
1   Institute of Radiology, Kardinal Schwarzenberg Hospital, Schwarzach im Pongau, Austria
,
Klaus Hergan
2   University Institute of Radiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria
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Abstract

Background Sex-specific disparities are well documented for cardiovascular disease (CVD). There are differences in physiology and pathophysiology, pain perception, spectrum of disease, risk, therapeutic aspects, prognosis, and outcome. CVD represents a broad spectrum of disorders. This review focuses on cardiovascular and cardiac pathology.

Method This review summarizes the current state of the literature on cardiovascular disease in women from a radiological viewpoint. It aims to provide a deeper understanding of these differences and thereby alerts the reader to the potential of CT and MRI for diagnosing CVD in women. Special attention is paid to disparities in the underlying physiological and pathophysiological processes, clinical presentation, and the quality of care to provide a deep understanding of the topic. Cardiovascular and cardiac pathologies with a sex-specific pattern of disease are presented and typical CT and MRI findings are arranged and illustrated with imaging findings.

Results and Conclusion Sex-specific differences are not only sex hormonal in nature but are rooted in the epigenome and encompass a multitude of physiological systems. In fact, cardiovascular disease shows sex-specific characteristics spanning from incidence to clinical presentation, course of disease, and prognosis. This is of significance regarding pretest probabilities, the power of tests, imaging strategies, and interpretation of imaging results. Key sex-specific issues encompass obstructive and non-obstructive coronary artery disease (CAD), microvascular angina, myocardial infarction with non-obstructive CAD, and coronary artery dissection. Sex-specific patterns are also noted in myocardial disease and heart failure such as pregnancy-related heart disease, Takotsubo syndrome, and anthracycline-induced cardiotoxicity.

Key points: 

  • Cardiovascular diseases have sex-specific characteristics.

  • Imaging strategies and interpretation of imaging results should be adjusted for women.

  • Imaging helps in the improvement of the sex-specific management of cardiovascular disease.

Zusammenfassung

Hintergrund Geschlechtsspezifische Unterschiede sind bei kardiovaskulären Erkrankungen gut dokumentiert. Sie beziehen sich auf Physiologie, Pathophysiologie, Schmerzwahrnehmung, Krankheitsspektrum, Risiko, therapeutische Aspekte, Prognose und Ausgang. Kardiovaskuläre Erkrankungen umfassen zahlreiche Krankheitsbilder. Diese Übersicht fokussiert auf kardiovaskuläre und kardiale Pathologien.

Methode Diese Übersicht fasst den aktuellen Stand der Literatur zu kardiovaskulären Erkrankungen bei Frauen aus einem radiologischen Gesichtspunkt zusammen. Ziel ist es, geschlechtsspezifische Unterschiede darzustellen und das Potenzial der CT- und MR-Bildgebung zu präsentieren. Besondere Aufmerksamkeit wird auf zugrunde liegende physiologische und pathophysiologische Prozesse gelegt, die Klinik und die Qualität der Versorgung, damit die Thematik umfassend verstanden werden kann. Kardiovaskuläre und kardiale Pathologien mit einem geschlechtsspezifischen Muster werden präsentiert und mit typischen CT- und MR-Befunden illustriert.

Ergebnisse und Schlussfolgerung Geschlechtsspezifische Unterschiede sind nicht nur durch Geschlechtshormone verursacht, sondern wurzeln im Epigenom und beziehen zahlreiche physiologische Systeme ein. Kardiovaskuläre Erkrankungen zeigen ein Spektrum geschlechtsspezifischer Charakteristika, das von der Inzidenz über die Klink, Krankheitsverlauf zur Prognose reicht. Das ist von Bedeutung für Vortestwahrscheinlichkeiten, Aussagekraft von Tests und für die Strategie und Interpretation der Bildgebung. Schlüsselthemen sind die obstruktive und nicht obstruktive koronare Herzerkrankung (KHK), die mikrovaskuläre Angina, der Herzinfarkt mit nicht obstruktiver KHK und die koronararterielle Dissektion. Geschlechtsspezifische Muster finden sich auch bei den Erkrankungen des Myokards und dem Herzversagen, wie bei den Schwangerschafts-assoziierten Herzerkrankungen, dem Takotsub- Syndrom und der Anthracyclin-induzierten Kardiotoxizität.

Kernaussagen: 

  • Kardiovaskuläre Erkrankungen haben geschlechtsspezifische Charakteristika.

  • Strategie und Interpretation der Bildgebung sollten für Frauen adaptiert werden.

  • Die Bildgebung unterstützt einen geschlechtsspezifischen Ansatz im Management von kardiovaskulären Erkrankungen.

Citation Format

  • Sommer OJ, Hergan K, . Kardiovaskuläre Erkrankungen: Was die Radiologin und der Radiologe wissen müssen. Fortschr Röntgenstr 2023; 195: 309 – 318

Key words

cardiac - heart - CT - CT angiography - MR imaging


Publication History

Received: 15 July 2022

Accepted: 16 October 2022

Article published online:
28 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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