Risk Assessment In Women Research Articles

Women's Ischemic Syndrome Evaluation: current status and future research directions: report of the National Heart, Lung and Blood Institute workshop: October 2-4, 2002: Section 1: diagnosis of stable ischemia and ischemic heart disease.

The WISE workshop was convened to review results from the Women’s Ischemic Syndrome Evaluation (WISE) study and other studies of ischemic heart disease to examine the nature and scope of gender differences in both chronic and acute cardiac ischemia, in terms of clinical manifestations, detection, and treatment. This section addresses research needs in improved diagnosis of myocardial ischemia in women. The chronic stable ischemia syndrome was traditionally viewed as reversible myocardial ischemia and obstructive macrovascular coronary artery disease (CAD) that limits blood flow during periods of increased myocardial oxygen demand. The symptom, typical angina pectoris, usually had a predictable, effort-induced threshold for provocation and a characteristic chest discomfort. Unless they had diabetes, women were thought to be generally spared from this syndrome until they became elderly.1 Relatively “fixed” stenoses were central to this syndrome, and dynamic changes in coronary size were believed infrequent and contributing to only occasional variability in the threshold for ischemia provocation. Finally, the smaller arteries and arterioles were thought to be relatively spared from disease, and hence, they were not likely to participate in the pathophysiology of the ischemic syndrome. Our more contemporary view includes both men and women (with the latter being more prevalent2,3) who have variable thresholds for ischemia and symptoms that may be typical or atypical for angina pectoris. This view also includes patients (more frequently women, but also men) who have symptoms but no flow-limiting large-vessel coronary stenoses. The pathophysiology of this variability, as well as of ischemia without flow-limiting stenoses, has now been confirmed to be due to dynamic changes in coronary size that also include the microcirculation.4 These findings often involve dysfunctional endothelium and have the potential to limit flow, causing ischemia …

The clinical role of stress myocardial perfusion imaging in women with suspected coronary artery disease.

Cardiovascular disease remains the number one cause of mortality for women in the United States, with coronary artery disease (CAD) accounting for 54% of all cardiovascular deaths. CAD claims the lives of more than 250,000 women each year and is therefore the single largest killer of American women. For several decades, the under-representation of women in clinical trials led to both a lack of available sex-specific evidence and a generalized misconception that CAD was a "man's disease." In actuality, not only are women vulnerable to CAD, they typically develop it 10 to 15 years later than men. Furthermore, sex differences exist in the mortality rates of women and men with CAD, such that once CAD is present in women, they have worse outcomes than their male counterparts. Consequently, early and accurate diagnosis of CAD is crucial for reducing mortality rates in women. Stress myocardial perfusion imaging (MPI) using contemporary techniques has been shown to have significant value in the diagnosis and prognosis of CAD in women. In the risk assessment of women with an intermediate clinical pretest likelihood of CAD, using MPI with exercise or pharmacologic stress has been shown to add incremental value to clinical variables or exercise electrocardiogram stress testing alone. This review discusses the clinical role of stress MPI in the management of women with suspected CAD.

Genetic risk assessment in women over 35: natural pregnancies compared to assisted reproductive technology pregnancies

The number of women of advanced maternal age (AMA), as well as the number of AMA women who utilize assisted reproductive technology (ART), has increased, yet very few studies have been conducted to understand their experience. The purpose of this study was to examine the differences in genetic risk assessment and decision-making between two groups of AMA women: those who had natural pregnancies and those who had ART pregnancies. The main hypothesis of the study was that AMA women with natural pregnancies would be more likely to elect prenatal diagnostic procedures than would AMA women with ART pregnancies because the latter would have greater anxiety about the risk of miscarriage. The alternative hypothesis was that the ART experience would desensitize women to invasive procedures, leading them to view prenatal diagnostic procedures as low-risk.The method used for study was a questionnaire, administered over a 7-month period of time at the Stanford University Hospital Genetic Counseling Clinic. Case study interviews were later conducted to obtain detailed information about individuals' experiences as women of advanced maternal age.The data indicated that the use of assisted reproductive technology did not shape the women's decision whether to undergo prenatal diagnostic testing, but the sample size was very small (p > .05). Trends in questionnaire and interview responses suggested that maternal age and the associated risk of fetal abnormality were the predominant factors shaping the risk assessment of the women in the study, not the use of ART. The alternative hypothesis, that ART may lead to desensitization toward prenatal diagnostic procedures, was supported by the interviews.

Better coronary risk assessment in women

Better coronary risk assessment in women

Diagnostic criteria and cancer risk of proliferative breast lesions.

Breast cancer risk assessment in women following a benign breast biopsy is a promising area with regard to intermediate endpoint determination, and has been particularly fostered by the consensus agreement concerning the risk attributed to specific diagnoses [1]. Several recent studies have largely verified this approach [2-4], and a recent report demonstrates general agreement among most expert pathologists regarding diagnostic criteria for these lesions [5]. However, in a limited number of cases, determining exact levels of risk for individual patients has been problematic as a result of a failure by pathologists to achieve consensus on diagnostic criteria for these same lesions. This situation has arisen primarily because it is much more tenable to disagree over subjective diagnostic criteria, than it is to argue with robustly supported epidemiological data. Without agreement on reproducible diagnostic criteria, widely promulgated consensus risk estimates for these specific histologic entities are no longer applicable. In addition, those individuals who choose different diagnostic criteria for proliferative breast lesions fail to realize that the terminology, epidemiological risk estimates, and diagnostic criteria used by Dupont and Page are inexorably linked. Since the publication of the consensus statement [1], those using the terms of "atypical ductal hyperplasia" and "atypical lobular hyperplasia" have by default accepted the diagnostic criteria of Dupont and Page. Therefore, surgical pathologists who desire to make use of the consensus risk estimates must familiarize themselves with diagnostic criteria for the various histologic entities that comprise proliferative disease of the breast as defined by Dupont and Page [6].(ABSTRACT TRUNCATED AT 250 WORDS)

Nuclear Cardiac Imaging: Principles and Applications.

1. A Brief Historical Perspective on Nuclear Cardiology 2. Radiation Physics and Radiation Safety 3. Imaging Instrumentation 4. Kinetics of Myocardial Perfusion Imaging Radiotracers 5. Acquisition, Processing and Quantification of Nuclear Cardiac Images 6. Image Artifacts 7. Myocardial Perfusion Single-Photon Emission Computed Tomography Attenuation Correction 8. Gated Single-Photon Emission Computed Tomography 9. Exercise Treadmill Testing and Exercise Myocardial Perfusion Imaging 10. Pharmacologic Stress Testing and Other Alternative Techniques in the Diagnosis of Coronary Artery Disease 11. Risk assessment in CAD 12. Use of Nuclear Techniques in the Assessment of Patients before and after Cardiac Revascularization Procedures 13. Diagnosis and Risk Assessment in Women 14. Evaluation of Patients with Acute Chest Pain Syndromes: Assessment with Perfusion Imaging in the Emergency Department 15. Fatty Acid and MIBG Imaging 16. Myocardial Perfusion Imaging in the Assessment of Therapeutic Interventions 17. Radionuclide Angiography 18. Positron Emission Tomography 19. Myocardial Viability/Hibernation 20. Other Heart Diseases 21. Development of Newer Radiotracers for Evaluation of Myocardial and Vascular Disorders 22. Nuclear Cardiology Compared to Other Imaging Methods 23. Cost-Effectiveness Analysis in Nuclear Cardiology 24. Interpreting and Reporting Nuclear Studies 25. ACC/AHA/ASNC Guidelines and Position Papers 26. Practical Aspects of Running a Nuclear Cardiology Laboratory

Mammographic Texture Analysis: An Evaluation Of Risk For Developing Breast Cancer

This paper deals with early and accurate breast cancer risk assessment for women. The use of texture analysis tools for the eventual development of an automatic system is proposed. In a first step, a standard procedure for obtaining x-ray mammograms is set up, the resulting radiographic images then being classified into four risk groups by a specialist. In a second step, specific and selected texture algorithms using both global and local statistical properties of the images are implemented. A number of x-ray mammograms have been studied. One of the resulting important observations is that it seems inappropriate to define a set of distinct classes of risk; rather, an increasing gravity degree correlated to a continuous evolution of the mammographic textures from the lowest to the highest degree of risk is to be preferred. Finally, a systematic comparison between the human classification and the numerical coefficients provided by the texture analysis is performed. The coefficients do not allow risk classification by themselves. A critical examination of these preliminary results leads us to a constructive discussion concerning the future developments of the proposed method.