The thickness of the coronary artery wall as measured by MRI is an independent marker for heart disease in women, according to a recently published study (Ghanem AM 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. 2019; 1(1):e180007 doi/10.1148/ryct.2019180007)
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 such as coronary computed tomography angiography (CCTA) tend to be used in patients with symptoms or more advanced cardiovascular disease, but are not recommended for wider 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, that occurs earlier in the course of heart disease than stenosis.
“Despite the significant advances in CCTA technology, it can be inappropriate to send all asymptomatic people to CCTA because of the exposure to radiation and the contrast nedia used for imaging,” said study lead author Dr. K Z. Abd-Elmoniem. “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, albeit small 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, Dr. 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 Dr. 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.”