Imaging Biomarkers in Primary Prevention of Cardiovascular Diseases
The webinar conducted by Imageens ( link) focused on the role of imaging biomarkers in primary prevention of cardiovascular diseases (CVD). The webinar featured two leading speakers: Professor Alban Redheuil, head of cardiovascular radiology at La Pitié Salpêtrière, and Dr. Antonio Gallo, a lipidologist in the cardiovascular prevention unit at the same institution.
Dr. Antonio Gallo provided an overview of the current state of primary prevention of cardiovascular diseases. He highlighted that cardiovascular diseases remain the leading cause of death worldwide, with strategies focused on reducing the prevalence and incidence of these conditions. The management of major risk factors, such as age, gender, family history, hypertension, hypercholesterolemia, diabetes, and more, plays a crucial role in prevention efforts. Challenges persist in achieving optimal therapeutic outcomes for patients at risk.
The speakers discussed the importance of medical imaging biomarkers in cardiovascular prevention. Traditional risk factor measurements (e.g., cholesterol, blood sugar, blood pressure) provide instantaneous snapshots of a patient’s status. However, medical imaging biomarkers offer insights into the chronic exposure to risk factors over time, helping identify patients at risk for cardiovascular events even before overt symptoms appear. Imaging of the vessels allows for the detection of subtle changes that might indicate underlying infraclinical conditions
The webinar explored the evolving landscape of imaging biomarkers in cardiovascular prevention. While classic risk factor assessment remains essential, imaging biomarkers offer a complementary perspective by providing a long-term view of a patient’s arterial health. This aids in identifying patients at greater risk and in need of more targeted interventions.
The speakers delved into the specific example of the “score of the distensibility of the ascending aorta” and its role in primary prevention of cardiovascular diseases. While not detailed in the provided text, this topic likely discussed the use of the ascending aorta’s distensibility as an imaging biomarker to assess arterial stiffness and potential cardiovascular risk.
Dr. Alban Redheuil continued the discussion by emphasizing the distinction between risk factors and direct visualization of diseases or their consequences. He agreed with Dr. Antonio Gallo’s point that imaging can provide biomarkers at the level of vessels and the heart that are directly linked to the pathology. Dr. Redheuil emphasized the importance of individual risk assessment, as population-level risk assessments provide probabilities but lack individualized insights.
He highlighted the emergence of new imaging techniques that allow direct visualization of vessel structures and functions, which can contribute to individual risk assessment. This concept challenges the historical association of biomarkers with blood-based markers. Dr. Redheuil pointed out that these imaging biomarkers aim to provide a long-term view of a patient’s health by assessing vessel health and pathology directly.
Dr. Redheuil discussed the use of various imaging biomarkers, including morphological and functional biomarkers. He highlighted the use of ultrasound for measuring intima and media thickness in carotid arteries as a validated technique. This biomarker has shown an association between increased thickness and higher cardiovascular risk. He mentioned the calcium score obtained through non-contrast CT scans, which has been successful in stratifying risk, especially in populations with specific conditions like familial hypercholesterolemia. The calcium score has proven effective in reclassifying patients at intermediate risk who were previously misclassified.
Additionally, Dr. Redheuil introduced the concept of pulse wave velocity, a measure of arterial stiffness, which is an emerging biomarker. He explained how this measure can help assess arterial aging and predict cardiovascular risk based on the speed of pulse wave propagation.
Dr. Redheuil concluded by underscoring that imaging biomarkers serve to affirm, quantify, and convince about disease risks. They provide information to both doctors and patients, aiding in risk assessment and patient understanding.
The webinar discussed the use of a novel imaging biomarker as well, the distensibility of the ascending aorta (AAD), as a potential tool for cardiovascular risk stratification. The AAD is seen as a promising marker due to its ability to assess central arterial stiffness, which can provide valuable insights into early stages of cardiovascular disease. This marker was discussed in comparison to traditional methods like the calcium score, which has limitations in predicting risk for certain populations. The potential of AAD to complement existing risk assessment tools was highlighted, particularly for patients with intermediate risk. The speakers emphasized the need for further research and collaboration to validate the utility of AAD for risk stratification and prevention. The discussion also touched on the broader role of cardiac MRI and its potential expansion in the field of cardiovascular health
