Fausto J. Pinto, MD, PhD, FESC, FACC; InĂªs Zimbarra Cabrita, MSc, BSc (Hons)
The impact of cardiovascular imaging on cardiovascular prevention and risk assessment has substantially increased over the last few years, mainly due to the amount of relevant information that imaging modalities now provide. This review discusses different aspects of cardiovascular imaging with respect to prevention and risk assessment, including (i) the role of carotid intima-media thickness as a risk marker and surrogate marker of atherosclerosis; (ii) the relevance of quantifying coronary calcium by computed tomography and the added value of computed tomography angiography; (iii) the ability of echocardiography to detect subclinical abnormalities early in the natural history of a disease process, potentially allowing early treatment and thus interrupting the cascade of events that can lead to adverse outcomes; (iv) the use of cardiac hybrid imaging as a way to obtain the ad- vantages of combining methods used simultaneously, and (v) the detection of vulnerable plaque and the role of some of the invasive imaging modalities such as intravascular ultrasound or optical coherence tomography. Further research is needed to document whether these approaches will prove clinically effective and have a positive cost/benefit ratio in the management and risk assessment of heart disease. This will likely represent an important step forward in the field of cardiovascular prevention.
With the development of new technologies applied to medical diagnostic pathways, cardiovascular imaging has rapidly progressed. Consequently, the clinical cardiologist has had to keep updated regarding the main characteristics, and particularly, the uses and indications, of these innovative diagnostic tools. The need to understand a new language is fundamental in the selection of diagnostic and therapeutic strategies for patients with heart disease- especially heart failure, which for many cardiovascular diseases is often the final endpoint Alongside standard diagnostic techniques, such as chest radiography, two-dimensional echocardiography, and cardiac Doppler, all of which are essential in daily practice, innovative tools have been playing an incremental role in cardiovascular imaging. Cardiac computed tomography (CT), cardiac magnetic resonance, ultrasound of intima-media thickness, speckle tracking, three-dimensional echocardiography, new applications in nuclear medicine, and more recently, "cardiac hybrid. imaging" and even molecular imaging are emerging as new tools for research and are also playing a pivotal role in risk. stratification.4.39 Whether the economic impact of these emerging technologies is sustainable is a question that the cardiology community will have to answer in the near future taking into consideration the cost/benefit ratio of the particular diagnostic tool to The main uses of these different imaging modalities in relation to what could be described as "prevention through imaging" will briefly be discussed in this review.