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Figure 10 | Journal of Nuclear Cardiology

Figure 10

From: Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease—state-of-the-evidence and clinical recommendations

Figure 10

Proposed clinical algorithm for the preferred initial diagnostic evaluation of symptomatic women with suspected stable ischemic heart disease with or without obstructive CAD. *Assumes test is locally available and ALARA principles for radiation dose reduction strategies (i.e., prospective ECG-gated CT, avoidance of dual-isotope and 201TI SPECT protocols, and preference for CZT and stress-only SPECT, or PET) are utilized whenever possible. **In cases where an anatomical strategy (i.e., CCTA or invasive coronary angiography) demonstrates absence of obstructive CAD, consider PET-CFR evaluation for coronary microvascular dysfunction. ***If nonobstructive CAD and/or coronary microvascular dysfunction is present, refer for guideline-directed therapies (where paucity of data and guidelines suggests more research is needed to define optimal therapies)

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