Cardiac MRI promising tool to detect heart disease early in women

Magnetic resonance imaging of the heart is certainly a useful tool for early detection of heart disease in women, according to a new study.

USA: Coronary vessel wall thickness (VWT) measured by MRI shows the strongest association with coronary artery disease (CAD) in women -- this could help clinicians in early identification of heart disease in women, shows a recent study published in the journal Radiology: Cardiothoracic Imaging. The study further found age to be the strongest risk factor for CAD in men.

Previous studies have demonstrated limitations of some cardiovascular risk assessment techniques for women, such as coronary CT angiography (CCTA) and Framingham Risk Score.

CCTA is used in patients showing symptoms or more advanced cardiovascular disease (CVD) but is not recommended for risk assessment among the general population showing no symptoms of heart disease. Framingham Risk Score provides estimates of CVD risk based on age, sex, and other factors and underestimates the chance of heart attacks and other cardiovascular events in asymptomatic women.

Cardiac MRI is growing in popularity owing to its capability to detect heart disease early. It can detect thickening of the arteries walls that occurs earlier in the course of heart disease than stenosis, or narrowing of 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 Dr. Abd-Elmoniem in a press release. "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."

The authors prospectively enrolled a total of 131 asymptomatic adults. All participants underwent CT angiography for scoring CAD, and coronary VWT was measured at 3.0-T MRI.

The analysis included 62 women and 62 men with low or intermediate Framingham score of less than 20%. Age (mean age, 45.0 years ± 14.5 [standard deviation]) and body mass index were not different between the 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."

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 Dr. 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.