Cardiovascular Imaging in Women with Heart Diseases, A local Clinical Practice Guidelines for Pakistani Population

This is the first time that a local preliminary document on gender differences in CVDs has been initiated in Pakistan. International forum has been highlighting significant gender and ethnicity in CVDs. So different countries from world took the initiative to develop their local guideline or clinical scientific statements on gender differences with different socio-cultural and educational background for their own countries. GRFW in collaboration with Scientific Council of Women with Heart Disease PCS Pakistan floated this idea to develop a local guideline in various aspects CVDs for our own women population. In this regard different topics were assigned to different groups including mostly female cardiologists, senior gynecologists/obstetricians and radiologist from all over Pakistan. Primary objectives of this write up on Cardiac Imaging in Women is to provide a local clinical practice guideline for the assessment and management of CVD that will improve and standardize the physicians’ decision making for Pakistani women population. In the setting of growing awareness of providing personalized precision medicine, addressing sex differences in CVD is a key goal. The intention is to inform cardiologists, non-cardiologist physicians’, general practitioners, and, obstetrician/gynecologists about the reasonable use and understanding of technologies to help in proper approach to their treating women with HDs and when to send them for cardiac specialist diagnostic center. As we could not find our own local data on cardiac imaging to report at present, most recommendations on cardiac imaging used has been taken from international literatures (which we have found feasible, readily available, and some cost effective approach in our money constraint society which can be followed in our population) and also which were published within the past decade were given priority. In this document, we discuss the role of using different cardiac imaging modalities, with a focus on diseases which are unique/or occur more in women. So, five women specific topics more commonly seen in our population were selected currently, which are (stable/unstable angina and ACS, MINOCA), non-ischemic CMP, HD during pregnancy, cardio-oncology, and connective tissue diseases (CTD). In these topics we have tried to used our own local incidences and prevalence of these diseases in our community/internationally on gender basis and have highlighted the availability/limitations of cardiac imaging in our society. The updated recommendations in women have been taken from international guidelines. Graphs and tables layout has been taken from abroad literatures and made some few changes according to its use in our population. You will find this a preliminary review document which will be simple to read, have updated approach in evaluating the diagnosis of HD in women easily. For current cost effectiveness issues for our population will be taken up by PCS to Health ministries of Pakistan for its making it easily availability with cheap cost so to benefit our female (very neglected and ill informed) with CVD population.