ORIGINAL PAPER Myocardial perfusion defects and coronary risk factors in symptomatic and asymptomatic elderly women Su Jin Lee Æ Kyung-Han Lee Æ So-Mi Park Æ Eun Jeong Lee Æ Hyun Woo Chung Æ Young Seok Cho Æ Joon Young Choi Æ Byung-Tae Kim Received: 25 February 2007 / Accepted: 14 August 2007 / Published online: 5 September 2007 Ó Springer Science+Business Media B.V. 2007 Abstract Background We investigated the relation between risk factors of coronary artery disease (CAD) and myocardial ischemia detected by 201 Tl SPECT in elderly women. Methods 306 women aged ‡75 yr (79.1 ± 3.6 yr) who underwent pharmaco- logic 201 Tl SPECT for suspected CAD based on symptoms or CAD risk factors were included. Coronary risk factors were evaluated by medical records, and included diabetes mellitus (DM), hyper- tension, hypercholesterolemia, cigarette smoking, greater age (‡80 yr), and obesity. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated based on stress and redistribution SPECT images for semi- quantification. Results The symptomatic group (n = 110) had a 34.5% perfusion defect rate. The asymptomatic group (n = 196) had a significantly lower perfusion defect rate of 16.8%. However, this significantly increased to 29.4% and 22.0% in the presence of diabetes mellitus (DM) and hypertension, respectively. In addition, the summed stress score of asymptomatic patients (12.4 ± 6.0) was not lower but comparable to that of symptomatic patients (10.0 ± 6.0). Conclusions In elderly women sus- pected of CAD, pharmacologic perfusion imaging can be used to identify myocardial ischemia in patients with angina as well as asymptomatic subjects with concurrent DM or hypertension. Keywords Coronary risk factor Á Elderly Á 201 Tl-SPECT Á Women Coronary artery disease (CAD), once erroneously considered a man’s disease, is a leading cause of death in women [1, 2]. More women than men die from CAD, up to 40% of initial cardiac events in women being fatal [1, 2]. Establishing effective diagnostic strategies for women suspected of CAD, however, is faced with special challenges including frequently atypical symptoms and risk factor profiles different from men [2–4]. Women have an age- specific incidence of CAD that reaches levels of males only by the seventh decade of life [3, 4]. Occurrence of CAD at an advanced age not only increases morbidity and mortality, but also further impedes diagnosis because silent ischemia is pre- valent and the capacity for exercise tests is poor [5]. Pharmacologic stress perfusion imaging is a valuable non-invasive test in such circumstances [6, 7] that may provide important information for managing elderly women suspected of CAD. However, the association of vasodilator induced perfusion S. J. Lee Á K.-H. Lee (&) Á S.-M. Park Á E. J. Lee Á H. W. Chung Á Y. S. Cho Á J. Y. Choi Á B.-T. Kim Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwondong, Kangnamgu, Seoul, Korea e-mail: khnm.lee@samsung.com S. J. Lee e-mail: suesj@samsung.com 123 Int J Cardiovasc Imaging (2008) 24:277–281 DOI 10.1007/s10554-007-9258-0