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Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions
Francesco Perone1, Marco Bernardi2, Alban Redheuil3
1Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa delle Magnolie", Castel Morrone, 81020 Caserta, Italy.
Insights
Optimal cardiovascular risk assessment is challenging, as current guidelines miss many at-risk individuals. Cardiovascular imaging offers a personalized approach to identify high-risk patients for improved primary and secondary prevention strategies.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Current risk assessment for primary prevention often fails to identify a significant proportion of individuals at risk for ischemic events.
- Existing guidelines and risk scores show discrepancies with daily practice, leading to missed opportunities for early intervention.
- Atherosclerotic cardiovascular disease (ASCVD) management is often homogeneous, despite evidence of heterogeneous risks for recurrent events.
Purpose of the Study:
- To review advances in cardiovascular imaging for enhancing risk stratification in primary and secondary prevention.
- To discuss the current role of cardiovascular imaging within clinical guidelines and identify evidence gaps.
- To explore perspectives on improving risk assessment and tailoring therapeutic strategies using cardiovascular imaging.
Main Methods:
- This narrative review synthesizes current literature on cardiovascular imaging techniques and their application in risk assessment.
- It analyzes data from major registries and clinical trials highlighting risk heterogeneity in ASCVD.
- The review examines existing guidelines and identifies areas for improvement in risk stratification.
Main Results:
- Cardiovascular imaging plays a pivotal role in categorizing individuals by risk profile, enabling personalized therapeutic strategies.
- Data indicate higher risks of recurrent ischemic events in patients with polyvascular or multivessel coronary disease, underscoring the need for individualized approaches.
- Current guidelines do not fully capture the heterogeneity of residual risk, particularly in high-risk subgroups.
Conclusions:
- Cardiovascular imaging is crucial for refining risk assessment beyond traditional scores, especially in primary and secondary prevention.
- Further research is needed to improve the definition of individual residual risk and intensify treatments for very high-risk subgroups.
- Personalized therapeutic strategies guided by cardiovascular imaging are essential for optimizing outcomes in patients with or at risk of ASCVD.
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.
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