ASNC Task Force on Women and Heart Disease: Perfusion Imaging in Women

For most of cardiology’s history, the model patient was a man, and the diagnostic tests were validated on men. This 2003 ASNC task force report is one of the early, deliberate efforts to fix that — to ask how heart disease should be detected in women specifically.

The problem it addresses is real and underappreciated. Women present with coronary disease differently, the standard exercise ECG performs less reliably in them, and the consequences of a missed diagnosis fall heavily on a group long assumed to be lower-risk. The task force argued that myocardial perfusion imaging, which looks at blood flow to the heart muscle rather than relying on the ECG alone, offered a more dependable answer in women, and it began to set out how that imaging should be used.

The honest caveat is the document itself. It is a brief, early consensus statement from a single subspecialty society, and the full text is not readily available for detailed appraisal — so it is best understood as a signpost in the history of sex-specific cardiac testing rather than a comprehensive modern protocol. The field, and the imaging technology, have advanced considerably since.

We rate the evidence moderate. Its lasting value is directional: it helped legitimize the idea that diagnostic strategy should account for sex — a principle now woven into mainstream guidelines, but not yet obvious when this was written.