Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

Abstract

Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published “Ten Things to Know About Ten Cardiovascular Disease Risk Factors.” Similarly, this “ASPC Top Ten Imaging” summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk – both important in preventive cardiology.

Ten things to know about ten cardiovascular disease risk factors – 2022

“…[1] The obesity epidemic and its adiposopathic consequences are leading contributors to major CVD risk factors such as type 2 diabetes mellitus, hypertension, and dyslipidemia that increase CVD risk, as well as other effects that directly increase CVD risk,[ 2 , 3 ] Central adiposity is the only physical exam component of the metabolic syndrome. [4] A Scientific Statement from the American Heart Association states:…”

“…Achieving lower levels of LDL-C often requires addition of other lipid-lowering drugs to statin therapy, such as ezetimibe, proprotein convertase subtilisin kexin (PCSK) 9 inhibitors, bempedoic acid, or bile acid binding resins. Imaging studies are another way to assess clinical ASCVD [93] , [148] . For example, computerized tomography coronary artery calcium (CAC) assessment can help stratify ASCVD risk and may be useful for patients at intermediate ASCVD risk, [149] when the decision to administer statin therapy is unclear [93] .…”

“…For example, computerized tomography coronary artery calcium (CAC) assessment can help stratify ASCVD risk and may be useful for patients at intermediate ASCVD risk, [149] when the decision to administer statin therapy is unclear [93] . Patients with CAC scores ≥ 400 AU are at high ASCVD risk [4] , [148] , [150] , 150 , 148 , 150 ] Perhaps as importantly, a CAC score of zero suggests a low risk of CVD risk. [4] Patients with a CAC score of ≥ 1000 AU represent a phenotype of extreme coronary atherosclerosis with mortality like high CVD risk patients.…”

“…Patients with CAC scores ≥ 400 AU are at high ASCVD risk [4] , [148] , [150] , 150 , 148 , 150 ] Perhaps as importantly, a CAC score of zero suggests a low risk of CVD risk. [4] Patients with a CAC score of ≥ 1000 AU represent a phenotype of extreme coronary atherosclerosis with mortality like high CVD risk patients. [ 4 , 151 ] Lipoprotein (a) is an LDL-like particle conjugated to apolipoprotein (a).…”

“… [4] Patients with a CAC score of ≥ 1000 AU represent a phenotype of extreme coronary atherosclerosis with mortality like high CVD risk patients. [ 4 , 151 ] Lipoprotein (a) is an LDL-like particle conjugated to apolipoprotein (a). Lp(a) is both atherogenic and thrombogenic and is an established CVD risk factor which can help stratify ASCVD risk.…”