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Published on: February 8, 2022
Extracardiac imaging biomarkers of cardiovascular health: a comprehensive review
Woo Jin Ahn1, In Young Choi2, Euddeum Shim2
1National Emergency Medical Center, National Medical Center, Seoul, 04539, Korea.
Insights
Extracardiac imaging reveals biomarkers for cardiovascular disease (CVD) risk. These findings, from routine scans, offer opportunistic assessment to improve patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) is a primary global health concern.
- Clinical risk factors and cardiac imaging are standard CVD assessments.
- Extracardiac imaging biomarkers offer complementary insights into cardiometabolic health.
Purpose of the Study:
- To explore the utility of extracardiac imaging biomarkers for cardiovascular risk assessment.
- To highlight how routine noncardiac imaging can identify individuals at risk for CVD.
- To emphasize the potential for opportunistic screening and improved risk stratification.
Main Methods:
- Review of existing literature on extracardiac imaging biomarkers.
- Analysis of associations between findings on noncardiac imaging (liver, kidney, pancreas, lung, brain, adipose tissue, muscle, vasculature, breast, bone) and cardiovascular outcomes.
- Identification of specific imaging markers such as nonalcoholic fatty liver disease (NAFLD), chronic kidney disease markers, pancreas volume, emphysema, cerebral small vessel disease, ectopic adiposity, sarcopenia, breast arterial calcification, and bone mineral density.
Main Results:
- Nonalcoholic fatty liver disease (NAFLD) on MRI, CT, and ultrasound independently predicts major adverse cardiovascular events (MACE).
- Kidney size, vascular calcification, renal resistive index, reduced pancreas volume, emphysema, cerebral small vessel disease, ectopic adiposity, sarcopenia, breast arterial calcification, and low bone mineral density are associated with adverse cardiovascular outcomes.
- These extracardiac markers provide prognostic value beyond traditional risk factors like body mass index.
Conclusions:
- Extracardiac imaging biomarkers identified on routine scans significantly improve cardiovascular risk stratification.
- Opportunistic assessment using these markers enables cost-effective and radiation-free screening.
- Standardization, validation, and integration into risk models are crucial for advancing precision cardiovascular medicine.
Abstract:
Cardiovascular disease (CVD) is the leading global cause of morbidity and mortality. Beyond clinical risk factors and cardiac imaging, extracardiac imaging biomarkers provide complementary insight into cardiometabolic health. Routine non-cardiac imaging often depicts the liver, kidneys, pancreas, lung, brain, adipose tissue, muscle, vasculature, breast, and bone, enabling opportunistic risk assessment. Non-alcoholic fatty liver disease (NAFLD), detectable on MRI, CT, and ultrasound, independently predicts major adverse cardiovascular events (MACE). Chronic kidney disease-related markers including kidney size, vascular calcification, and renal resistive index also correlate with adverse outcomes. Reduced pancreas volume is similarly associated with cardiovascular disease. CT-quantified emphysema and lung hyperinflation are associated with coronary artery disease and cardiovascular mortality. Cerebral small vessel disease markers, such as white matter hyperintensities and silent brain infarcts, demonstrate associations with cardiovascular events. Ectopic adiposity and sarcopenia quantified by CT, MRI, and ultrasound add prognostic value beyond body mass index. Extracardiac vascular and skeletal biomarkers, such as breast arterial calcification and low bone mineral density, further associate with cardiovascular morbidity and mortality. Collectively, these markers improve risk stratification and enable screening without added cost or radiation. Future priorities include standardization, external validation, and integration into risk prediction models to advance precision cardiovascular medicine.
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