The Vall d'Hebron Research Institute (VHIR), in collaboration with the CIBER of Cardiovascular Diseases (CIBERCV) and the CIBER of Epidemiology and Public Health (CIBERESP), has developed a risk score that improves the prediction of severe cardiovascular events, such as heart attack or cardiac death, specifically in women. This advance, published in Radiology: Cardiothoracic Imaging, the official journal of the Radiological Society of North America (RSNA), allows for better identification of high-risk cases and the personalization of treatments to reduce complications.

Inequality in cardiovascular research

Cardiovascular diseases are the leading cause of death for both men and women. However, since men are more likely to suffer from heart disease, women tend to be underrepresented in scientific studies. “Women are often underrepresented in research studies, and in some settings, may be excluded,” explains Dr. Guillermo Romero-Farina, cardiologist at the Vall d'Hebron University Hospital and principal investigator at VHIR and CIBERCV. “Risk stratification in women is particularly important because the clinical presentation of coronary disease in women may differ from that in men and is often atypical,” he adds.

The Vall d'Hebron team has worked to combat this inequality with a scoring model that integrates clinical data, such as age or the presence of diabetes, with advanced cardiac imaging information obtained through gated SPECT technology. This technique allows for the simultaneous assessment of left ventricular function (contraction and relaxation) and myocardial perfusion (whether all areas of the heart receive adequate blood and oxygen).

How does the CORSWO score work?

Coronary risk stratification models are a key tool for healthcare professionals to identify which patients are most likely to experience severe cardiovascular events, such as heart attacks, strokes, or even death. The establishment of a risk score tailored to women can help predict significant cardiovascular events with greater accuracy.

In this retrospective study, Dr. Romero-Farina's team analyzed data from 2,226 women aged between 40 and 93 who came to Vall d'Hebron for risk assessments. The average follow-up was four years, with a maximum of ten years. All patients underwent the cardiac imaging technique known as gated SPECT myocardial perfusion, both under stress and at rest.

Using eight variables, the researchers developed the CORSWO score, based on the results of gated SPECT combined with clinical variables such as age, the presence of diabetes, exercise level, and other cardiac imaging data. This score stratifies patients into four risk levels: low, moderate, high, and very high. “By grouping patients into different risk levels -ranging from low to very high risk- doctors can better focus resources and treatment on those who need them the most” explains Dr. Guillermo Romero-Farina.

The model accurately predicted major adverse cardiovascular events in women classified as high or very high risk. However, the researchers will continue studying which patient groups might benefit most in the future from additional techniques, such as coronary calcium quantification or myocardial blood flow assessment.

A pioneering model in female cardiovascular analysis

Currently, there are very few cardiac risk stratification models designed exclusively for women. Most models analyze overall cardiovascular risk, rather than specifically cardiac risk. Furthermore, when adding data from cardiac imaging, such examples are even more scarce and are not easily comparable with other algorithms.

Predictive models based on clinical data and biomarkers have existed before, but the integration of cardiac imaging significantly increases the prognostic value. This multiparametric approach had already been demonstrated by Vall d'Hebron in the VHRS-I, VHRS-II, and VHRS-ICM series published between 2020 and 2023, in which nearly 10,000 patients were studied.

“Our study provides additional insights into identifying high risk or very high risk women, helping to detect severe complications early. This approach addresses one of cardiologists’ main concerns: preventing fatal outcomes before it is too late,” concludes Dr. Guillermo Romero-Farina.