[Radiological imaging to assess individual cardiovascular risk]
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A D Ordu1, K Rippel1, L T Garthe1
1Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
Insights
Coronary calcium scans and coronary CT angiography (CTA) are effective for assessing individual cardiovascular risk. CTA offers higher incremental value than calcium scores, improving outcomes in symptomatic patients.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Accurate estimation of individual cardiovascular risk is crucial for preventing cardiovascular diseases.
- Coronary calcium scans and coronary CT angiography (CTA) are established methods for cardiovascular risk assessment.
Purpose of the Study:
- To summarize evidence for calcium score and coronary CTA in cardiovascular risk stratification.
- To illustrate the significance of these imaging tests in current clinical guidelines.
Main Methods:
- Review of existing evidence on the prognostic value of coronary calcium scans and coronary CTA.
- Analysis of guideline recommendations for the use of these imaging modalities.
Main Results:
- Both calcium score and coronary CTA demonstrate high prognostic value, exceeding traditional risk-factor-based assessments.
- Coronary CTA provides higher incremental prognostic value compared to the calcium score.
- Recent trials show improved outcomes in symptomatic patients undergoing CTA compared to standard care.
Conclusions:
- European and US guidelines recommend calcium scoring for risk stratification in asymptomatic patients with low to intermediate risk.
- Coronary CTA is recommended for symptomatic patients with a low to intermediate pretest probability of coronary artery disease.
Clinical/Methodical Issue:
Radiologic imaging for the assessment of individual cardiovascular risk.
Standard Radiological Methods:
The correct estimation of the individual cardiovascular risk is prerequisite for the prevention of cardiovascular diseases. Here, extensive evidence is available for coronary calcium scans as well as coronary CT angiography (CTA).
Methodical Innovations:
Summary of the available evidence for the use of calcium score and coronary CTA. Illustration of the significance of both tests in current guidelines.
Performance:
Both tests have high prognostic value, surpassing a risk-factor based assessment. In comparison with the calcium score, the CTA has higher incremental value.
Achievements:
Results from recent trials confirm an improvement of outcomes in symptomatic patients by performing a CTA compared with standard care.
Practical Recommendations:
European and US guidelines recommend a calcium score for risk stratification of asymptomatic patients with a low to intermediate risk profile. For symptomatic patients with low to intermediate coronary artery disease pretest probability, a CTA is recommended.
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