Advanced cardiovascular imaging in immune-mediated inflammatory diseases: redefining ischemic heart disease risk

Purpose of review Immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis (PsO), and systemic sclerosis (SSc) are associated with significantly increased risk of ischemic heart disease (IHD), driven by chronic inflammation, and often compounded by undertreated traditional cardiovascular risk factors. Conventional risk scores frequently underestimate this burden. Recent findings Advanced cardiovascular imaging techniques, such as coronary CT angiography (CCTA), cardiac magnetic resonance (CMR), and nuclear imaging techniques, offer enhanced detection of subclinical atherosclerosis, myocardial inflammation, and coronary microvascular dysfunction. Summary This review highlights the role of imaging tools in improving risk stratification and guiding personalized care, while underscoring the need for ongoing research to validate their clinical utility and ensure equitable implementation.