News | Womens Cardiovascular Health | April 25, 2019

Women With Coronary Artery Wall Thickness at Risk for Heart Disease

Study underscores cardiac MRI as promising tool for early detection of coronary artery disease

Women With Coronary Artery Wall Thickness at Risk for Heart Disease

April 25, 2019  – The thickness of the coronary artery wall as measured by magnetic resonance imaging (MRI) is an independent marker for heart disease in women, according to a study published in the journal Radiology: Cardiothoracic Imaging.1

Previous research has found limitations in cardiovascular risk assessment for women. For instance, there is evidence that the commonly used Framingham Risk Score, which provides estimates of cardiovascular disease risk based on age, sex and other factors, underestimates the chance of heart attacks and other cardiovascular events in asymptomatic women. Imaging tools like coronary computed tomography angiography (CCTA) tend to be used in patients with symptoms or more advanced cardiovascular disease, but are not recommended for liberal use in risk assessment among the general population with no cardiac symptoms.

Recently, cardiac MRI has emerged as a promising tool for early detection of coronary artery disease. MRI can detect thickening in the walls of the arteries, a change that occurs earlier in the course of heart disease than stenosis, or narrowing of the arteries.

“Despite the significant advances in CCTA technology, it is not appropriate to send all asymptomatic people to CCTA because of the exposure to radiation and chemical dyes used for imaging,” said study lead author Khaled Z. Abd-Elmoniem, Ph.D., M.H.S., from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH) in Bethesda, Md. “MRI might be a safe alternative that can be used more broadly to assist in the diagnosis of coronary artery disease without exposing patients to a procedure that carries some risk. The advantage of MRI in this situation is that it can tell us that there is a thickening before stenosis, which is difficult to do with CCTA.”

Over a period of years, Abd-Elmoniem and colleagues developed and refined an MRI technique that adjusts for the motions of breathing and the beating heart to directly visualize coronary wall thickness. They used the technique to assess coronary artery disease in 62 women and 62 men with low to intermediate risks based on their Framingham scores. The patients also underwent CCTA to investigate the association between vessel wall thickness and CCTA-based coronary artery disease scores.

The results showed stark differences between the two groups.

“When we separated the patients into men and women, coronary artery disease in men was, as expected, associated with aging and a high Framingham score,” said Abd-Elmoniem. “However, in women, both age and the Framingham score were not factors. Vessel wall thickness, as measured by MRI, was the strongest variable associated with coronary artery disease.”

The results point to a potential future role for vessel wall thickness measurements in identifying opportunities for early lifestyle changes or treatment in a young, asymptomatic population. Unlike CCTA, cardiac MRI does not require radiation or contrast dyes.

“A single image and measurement of coronary vessel wall thickness with MRI can be used to gauge the extent of coronary plaque in asymptomatic women, who then can be appropriately referred for further exams and/or treatment,” said Abd-Elmoniem.

While further studies are needed, these results emphasize the unique nature of coronary artery disease development in women compared to men, and show that MRI could one day be a useful tool in the prevention and management of the disease in women, especially for those with intermediate risk.

“MRI provides another way to help guide physicians toward therapy,” said NIDDK’s Ahmed M. Gharib, M.D., a co-author on the paper. “Since it can be repeated, it can also be useful in monitoring the effectiveness of any therapy.”

Gharib, who heads the NIDDK Biomedical and Metabolic Imaging Branch, said the study results represent the fruits of a collaboration across multiple disciplines.

“This is a wonderful example of how a multidisciplinary team of biomedical engineers and radiologists can expedite translational research to clinical radiological applications,” he said.

For more information: www.pubs.rsna.org/journal/radiology

Related Women's Cardiovascular Health Content

VIDEO: Differences in Cardiac Complications and Presentation Between Men and Women

Diagnostic Differences in Women’s Heart Health

VIDEO: Sex Differences in Diagnosing Heart Disease in Women

 

Reference

1. Ghanem A.M., Matta J.R., Elgarf R., et al. Sexual Dimorphism of Coronary Artery Disease in a Low- and Intermediate-Risk Asymptomatic Population: Association with Coronary Vessel Wall Thickness at MRI in Women. Radiology: Cardiothoracic Imaging, published online April 25, 2019. https://doi.org/10.1148/ryct.2019180007

Related Content

World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...
Insomnia Tied to Higher Risk of Heart Disease and Stroke

Image courtesy of the American Heart Association

News | Cardiac Diagnostics | August 19, 2019
People suffering from insomnia may have an increased risk of coronary artery disease, heart failure and stroke,...
Evolutionary Gene Loss May Help Explain Human Predisposition to Heart Attacks
News | Cardiac Diagnostics | July 29, 2019
The loss of a single gene two to three million years ago in our ancestors may have resulted in a heightened risk of...
U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
Overlay Init