Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions

Author:

Perone Francesco1ORCID,Bernardi Marco2ORCID,Redheuil Alban3,Mafrica Dario2,Conte Edoardo4ORCID,Spadafora Luigi2ORCID,Ecarnot Fiona5ORCID,Tokgozoglu Lale6,Santos-Gallego Carlos G.78ORCID,Kaiser Sergio Emanuel9ORCID,Fogacci Federica10ORCID,Sabouret Annabelle11,Bhatt Deepak L.8ORCID,Paneni Francesco1213,Banach Maciej1415ORCID,Santos Raul16,Biondi Zoccai Giuseppe1718ORCID,Ray Kausik K.19,Sabouret Pierre20ORCID

Affiliation:

1. Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy

2. Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy

3. Laboratoire d’Imagerie Biomédicale, Sorbonne University, INSERM 1146, CNRS 7371, 75005 Paris, France

4. Cardiology Department, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20100 Milan, Italy

5. Department of Cardiology, University Hospital Besancon, University of Franche-Comté, 25000 Besancon, France

6. Department of Cardiology, Medical Faculty, Hacettepe University, 06230 Ankara, Turkey

7. Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

8. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA

9. Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro 23070-200, Brazil

10. Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy

11. Gustave-Roussy Institute, Hérault Department, 94805 Villejuif, France

12. Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland

13. Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland

14. Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland

15. Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland

16. Heart Institute, University of Sao Paulo Medical School, São Paulo 05403-903, Brazil

17. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy

18. Mediterranea Cardiocentro, 80122 Napoli, Italy

19. Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Department of Public Health and Primary Care, Imperial College London, London SW7 2BX, UK

20. Heart Institute, Cardiology Department, Paris and National College of French Cardiologists, Pitié-Salpétrière Hospital, Sorbonne University, 75013 Paris, France

Abstract

Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging.

Publisher

MDPI AG

Subject

General Medicine

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