Advanced multimodality imaging, including CAC scoring and CCTA, enhances the identification of subclinical atherosclerosis and supports individualized risk assessment beyond traditional risk scores.
Does advanced multimodality imaging improve risk stratification and identification of subclinical atherosclerosis in individuals at very high cardiovascular risk without a previous cardiovascular event?
Advanced multimodality imaging enhances the identification of subclinical atherosclerosis and supports individualized risk assessment in primary prevention for high-risk patients.
A substantial proportion of cardiovascular (CV) events occurs in individuals without previously diagnosed CV disease, underscoring the need for improved primary prevention strategies. Traditional risk scores provide probabilistic estimates but fail to directly identify the presence and heterogeneity of subclinical atherosclerosis. This review summarizes current evidence on advanced multimodality imaging approaches for identifying high-risk individuals without prior CV events. Evidence from cohort studies, randomized trials, and meta-analyses was examined to evaluate the role of coronary artery calcium (CAC) scoring, coronary computed tomography angiography (CCTA), perivascular fat attenuation index (FAI), and vascular ultrasound in risk stratification. CAC scoring remains the most validated and widely recommended tool, offering robust prognostic value and significant risk reclassification, particularly in intermediate-risk individuals. CCTA provides additional insights into plaque burden and high-risk phenotypes, while FAI enables noninvasive assessment of coronary inflammation, improving risk prediction beyond anatomical measures. Vascular ultrasound offers a radiation-free, accessible method for detecting systemic plaque burden and refining risk estimation. Overall, multimodality imaging enhances the identification of subclinical disease and supports more individualized, disease-based risk assessment. Future research should clarify cost effectiveness, optimize patient selection, and determine whether imaging-guided strategies improve long-term clinical outcomes.
Marzano et al. (Sat,) conducted a review in Very high cardiovascular risk without a previous cardiovascular event. Advanced multimodality cardiovascular imaging vs. Traditional risk scores was evaluated. Advanced multimodality imaging, including CAC scoring and CCTA, enhances the identification of subclinical atherosclerosis and supports individualized risk assessment beyond traditional risk scores.