At Medical Imaging, we serve a large audience that is incredibly varied in its specialties, and we attend a number of industry-related events throughout the year focused on these different areas. It's always clear when the annual meeting of the American College of Cardiology (ACC of Bethesda, Md) is just around the corner. In the weeks leading up to the meeting, media outlets are rife with information about coronary artery disease—the leading cause of death and disability in the United States. (In fact, our cover story is all about cardiac imaging and the significant advances made in the field over just the past year).

One of the stories recently highlighted was the results of the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. This 8-year study, led by C. Noel Bairey Merz, MD, FACC, of Cedars-Sinai Medical Center (Los Angeles), tracked about 1,000 women from a total of four clinical sites in Florida, Pennsylvania, and Alabama who were suffering from chest pains but whose angiograms did not show evidence of blockage.

Researchers determined that 80% of women who have evidence of myocardial ischemia and open arteries have diffused plaque, and 50% had abnormalities of function in the small arteries. "What is new is that we used to say these women had false-positive treadmills, false-positive evidence of damage to their heart, or that the EKG was a false positive," Bairey Merz said in a recent phone interview. "Now, it's looking like at least half of the time, these abnormalities are correlating with abnormalities of the function of the small vessels in the heart."

Based on national cath lab data registries and their research in the WISE study, Bairey Merz and her co-researcher, Leslee J. Shaw, PhD, have projected that an estimated 2–3 million women in the United States suffer from this condition.

Alas, imaging to the rescue. SPECT exams are an option, of course, as they traditionally have been an accurate measure of large coronary artery blockages. Also, Bairey Merz and her team are piloting cardiac MR perfusion testing. They'll be looking at a coronary flow parameter—"which is a nonimaging parameter, but it is a measurement of the blood flow, and that could potentially be a very good test," she said. "Just because you can't see the arteries doesn't mean they aren't a problem, right? That's exactly what we found out in the WISE study." Also with cardiac MR, researchers will be able to see the subendocardial layer of the heart, which is the area that "gets into trouble" with small-vessel disease.

The real message here, though, is that women who have presented with chest pain but have been told that the angiogram indicates open arteries, that there isn't an explanation for their abnormal stress test, and that their SPECT is a false positive—should be given yet another look.

Look for further discussion of the WISE results at the upcoming ACC March 11–14 in Atlanta. As always, please stop by Booth 3919 at ACC in Atlanta to say hello and share with me the interesting developments in cardiac imaging that you've heard about, read about, or seen. Based on the coverage that the body's powerhouse has received thus far, I'm sure we'll have plenty to discuss! For me, this is one of the best parts about attending all of these different industry events—the opportunity to meet so many Medical Imaging readers. See you there!

Andi Lucas
Editor