Imaging of Heart Disease in Women

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 4.00
Procedures: 4.00
Diagnostic and Electrophysiology Procedures: 4.00

Computed Tomography: 3.00
Procedures: 3.00
Neck and Chest: 3.00

Nuclear Medicine Technology: 3.00
Procedures: 3.00
Cardiac Procedures: 3.00

Registered Radiologist Assistant: 4.00
Procedures: 4.00
Thoracic Section: 4.00

Outline

1. Introduction
2. Challenges of Noninvasive Detection of Heart Disease in Women
   1. Sex-based Differences in Anatomy and Physiology
   2. Radiation Exposure
   3. Pregnancy
   4. Sex-based Differences in Presentation and Pathogenesis of IHD
3. Noninvasive Detection of IHD in Women
   1. Exercise ECG
   2. Stress Imaging
   3. Cardiac MR Imaging
   4. Coronary CT Angiography
4. Nonischemic Cardiomyopathy
   1. Stress-induced Cardiomyopathy
   2. Sarcoidosis
   3. Chronic Inflammatory Diseases
5. Heart Diseases in Pregnancy
   1. Normal Hemodynamic Alterations during Pregnancy
   2. Peripartum Cardiomyopathy
6. Conclusion

Objectives

Upon completion of this course, students will:

1. describe the percentage of patients with stress-induced cardiomyopathy who are women
2. list the diseases whose combined female deaths in 2010 equaled that of cardiovascular disease
3. list the differences in heart disease prevalence and prognosis between women and men
4. describe the anatomic differences between men and women that would affect the diagnostic performance of ECG and cardiac imaging in women
5. identify the female hormone that can cause false-positive exercise ECG changes in women
6. describe the prevalence of obesity among adult women from 2010 to 2014
7. list the CT image artifacts that can be caused by obesity
8. identify the organization that issued new recommendations in 2007 regarding the tissue weighting factor for breast tissue
9. list the organs that have a tissue weighting factor of 0.12
10. list the imaging modalities considered to be first-line cardiac examinations during pregnancy
11. describe the stochastic effects that may be caused by ionizing radiation
12. identify the radiation dose model that applies to stochastic effects from ionizing radiation
13. describe the dose of radiation that doubles the relative risk of childhood carcinogenesis from 0.1% to 0.2%
14. describe the radiation dose threshold that is traditionally used when considering deterministic effects of ionizing radiation exposure
15. identify the cardiac imaging modality that results in the highest fetal radiation exposure
16. describe the trimester of pregnancy during which the ACR considers MR imaging safe
17. list the recommendations for decreasing fetal specific absorption rate during MR imaging
18. identify the FDA category of agents in which intravenous iodinated contrast agents are listed
19. describe clinically significant CAD as defined by the American College of Cardiology
20. describe the age difference between women and men and their presentation with IHD
21. list the cardiac risk factors included in the term metabolic syndrome
22. list the causes of hormonal alterations that may potentiate or amplify coronary microvascular disease in women
23. apply the interaction of MBF and CFR to the evaluation of coronary blood flow
24. identify the noninvasive test that has the lowest sensitivity for CAD in women
25. identify the noninvasive test that has the highest specificity for CAD in women
26. list the quantifiable physiologic parameters that are surrogate markers of microvascular function
27. describe the diagnostic criteria for IHD at exercise ECG
28. identify the noninvasive test that is valuable for ruling out obstructive CAD and predicting event-free survival
29. identify the initial noninvasive test recommended by the AHA for women with adequate exercise capacity and a normal resting ECG
30. list the diagnostic tools above which stress imaging provides incremental value
31. list the diagnostic tests that should be considered for symptomatic women at intermediate to high risk for CAD with poor exercise capacity
32. describe the imaging findings that form the cornerstone of diagnosis with SPECT and PET radionuclide MPI
33. list the reasons why ^99mTc radiopharmaceuticals are preferred over ²⁰¹Tl for SPECT MPI
34. list the superior characteristics of PET MPI when compared to SPECT MPI
35. describe the mathematical process for quantification of CFR
36. list the imaging modalities with a class I recommendation from the American Heart Association
37. list the imaging modalities that offer the ability to quantify MBF
38. describe the annual mortality rate among patients with normal CT angiography results
39. describe the techniques with the potential to improve the diagnostic accuracy of coronary CT angiography
40. describe the diagnostic criteria for stress-induced cardiomyopathy proposed by the Mayo Clinic
41. describe the percentage of patients with sarcoidosis that demonstrates cardiac involvement at autopsy
42. identify the test of choice for diagnostic evaluation of sarcoidosis
43. identify the radionuclide imaging procedure with the highest sensitivity for detecting active myocardial inflammation in sarcoidosis
44. list the traditional risk factors for CAD that may be seen in patients with SLE or rheumatoid arthritis
45. describe the anatomic location for the more common granulomatous form of myocarditis in rheumatoid arthritis
46. describe the prevalence of cardiovascular disease during pregnancy in the United States
47. describe the increase in cardiac output seen during pregnancy
48. list the cardiac valves that may exhibit transient and mild regurgitation during pregnancy
49. list the factors that may predict a poor prognosis for women with peripartum cardiomyopathy
50. identify the laboratory blood tests that are recommended for the assessment of peripartum cardiomyopathy