Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention

Abstract

Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered around lifestyle changes, risk factors management, and medication. However, the integration of imaging methods offers a novel dimension in early disease detection, risk assessment, and ongoing monitoring of at-risk individuals. Imaging techniques such as supra-aortic trunks ultrasound, echocardiography, cardiac magnetic resonance, and coronary computed tomography angiography have broadened our understanding of the anatomical and functional aspects of cardiovascular health. These techniques enable personalized prevention strategies by providing detailed insights into the cardiac and vascular states, significantly enhancing our ability to combat the progression of CVDs. This review focuses on amalgamating current findings, technological innovations, and the impact of integrating advanced imaging modalities into cardiovascular risk prevention, aiming to offer a comprehensive perspective on their potential to transform preventive cardiology.

Keywords: cardiac resonance imaging; cardiovascular prevention; cardiovascular risk factors; coronary computed tomography angiography; echocardiography.

Figure 1

How imaging redefines cardiovascular prevention.

Figure 2

Supra-aortic trunks ultrasound: (a) short axis view of internal carotid artery stenosis with calcific plaque; (b) pulsed wave Doppler spectrum of an internal carotid artery with not hemodynamically relevant stenosis; (c) long axis view of a calcific plaque of internal carotid artery; (d) normal pulsed wave Doppler spectrum of a vertebral artery.

Figure 3

Carotid-femoral pulse wave velocity measurement: (a) normal value of pulse wave velocity in a young man without cardiovascular risk factors; (b) increased pulse wave velocity in a 78-year-old male smoker with hypertension and type 2 diabetes.

Figure 4

A 65-year-old male smoker with hypertension and dyslipidemia underwent coronary artery calcium (CAC) score calculation for exertional angina. CAC score value is increased in the absence of critic lesions. CAC—coronary artery calcium; CCTA—coronary computed tomography angiography; Cx—circumflex artery; LAD—left anterior descending artery; LM—left main.

Figure 5

Coronary computed tomography angiography: A 75-year-old female patient with hypertension, diabetes, and dyslipidemia underwent CCTA as a screening procedure before TAVI intervention. The CCTA shows widespread atherosclerotic disease in all three vessels with extensive non-critical calcified lesions. Abbreviations: CCTA—coronary computed tomography angiography; Cx—circumflex artery; LAD—left anterior descending artery; RCA—right coronary artery; TAVI—transcatheter aortic valve implantation.

Figure 6

Photon-counting detector CT angiography (PCD-CTA) of the heart showing coronary stent implantation in the proximal left anterior descending artery (LAD) (yellow arrow in a–c). Three-dimensional cinematic rendering of the heart, showing the stent in the LAD (a), three-dimensional rendering of the ascending aorta and left coronary artery and the stent in proximal LAD (b), curved multiplanar reformation showing the absence of in-stent stenosis (c).

Figure 7

Quantification of epicardial fat by cardiac magnetic resonance imaging in a 55-year-old obese, smoking, dyslipidemic male patient with poor echocardiographic acoustic window and symptomatic for exertional angina.