Sex specific issues relating to nuclear cardiology.

Coronary heart disease is a major source of morbidity and mortality in women. Despite the importance of this health problem, women in general have not received the same degree of aggressiveness in diagnosis and treatment as men have received. Contributing to underdiagnosis and undertreatment in women include the results of the Framingham study, which showed that women with angina have better prognoses than men, and the results of multicenter percutaneous transluminal coronary angioplasty and coronary artery bypass grafting trials, which showed that women have higher morbidity and mortality rates in the periprocedure periods. These higher morbidity and mortality rates can largely be explained by the older ages of women when they have symptomatic coronary heart disease and the attendant higher incidence of comorbid diseases in an elderly population. Because of the cardiovascular protective effects of estrogen, the incidence of disease of the epicardial coronary arteries in the absence of significant risk factors in premenopausal women is very low despite the fairly high incidence of chest pain syndromes. Some of these women may have endothelial dysfunction, some small vessel disease, and some may have the visceral pain syndrome. When coronary heart disease does present in middle-aged women, it tends to be less severe than in middle-aged men. The recognized limitations of stress perfusion imaging in single vessel disease, as well as resolution limitations in small hearts and limitations due to soft tissue attenuation artifacts, all must be considered when imaging women. Applications of nuclear techniques to some of the unique aspects of chest pain in women such as small vessel disease or endothelial dysfunction represent as yet unmet challenges.