Diagnostic importance of myocardial perfusion scintigraphy in women with suspected coronary artery disease

Coronary artery disease is the leading cause of mortality both in men and women. Recent surveys indicate that coronary artery disease is still under diagnosed and exploitation of diagnostic modalities is unsatisfactory. High level of false positive and non diagnostic tests results conducted in population of women is a fact. Adequate assessment of cardiovascular risk and use of appropriate diagnostic modalities improve diagnostic accuracy in coronary artery disease detection. Treadmill exercise test is recommended initial test, however low accuracy and high level of false positive results is documented, mostly in young women and in subpopulation with low risk of coronary artery disease. Myocardial perfusion scintigraphy SPECT is a noninvasive imaging modality. This technique permits identification of perfusion defects and areas of reduced myocardial blood flow, as a consequence of coronary artery narrowing. Myocardial perfusion scintigraphy SPECT is of proven high diagnostic and prognostic value in general population and also selectively in women suspected of coronary artery disease. The technique is recommended in patients with an intermediate to high cardiovascular risk post treadmill test. It also initiates the diagnostic procedures in a group of patients with contraindications for treademill test, unable to exercise sufficiently or incapable of exercise. Moreover it is proved that myocardial perfusion scintigraphy SPECT provides incremental value over exercise ECG in women suspected of coronary artery disease. Last decade technical and software improvement, dedicated gamma cameras, gated SPECT or SPECT/CT further increased the diagnostic and prognostic accuracy of myocardial perfusion scintigraphy in the evaluation of symptomatic women with intermediate to high risk of coronary artery disease.