Journal of Surgical Pathology and Diagnosis

Women with coronary artery disease have a worse short and long-term prognosis than men and the prevalence of atherosclerotic cardiovascular disease is rising. Women are less likely than men to present with classic anginal symptoms and are more likely to be misdiagnosed. There are several non-invasive imaging modalities available for diagnosing ischemic heart disease in women and many of these modalities can also help with prognosis and management. Choosing the best imaging modality to evaluate women with possible ischemic heart disease is a scenario that clinicians frequently face. Earlier modalities, such as exercise treadmill testing, show significant gender differences in performance, whereas newer modalities, such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging, are highly specific and sensitive for detecting ischemia and coronary artery disease with greater gender parity. Individual factors such as availability, diagnostic performance and female-specific considerations such as pregnancy status may all have an impact on the decision to use one modality over another. Emerging techniques for diagnosing ischemia and coronary microvascular dysfunction include strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging.

Exercise stress testing (EST) has limited diagnostic power for obstructive coronary artery disease (CAD). The analysis of heart rate variability (HRV) may improve the sensitivity of CAD detection. The purpose of this study was to look at the relationship between short-term HRV and myocardial ischemia during EST, specifically the acceleration, maximum and recovery stages of heart rate (HR). HRV during EST was compared in 19 healthy (RHC) subjects and 35 CAD patients (25 with insignificant CAD (iCAD) and 10 with significant CAD (sCAD)). As a result, at the maximum stage, all HRV indices decreased and no significant differences between iCAD and sCAD were discovered.