AMERICAN COLLEGE OF RADIOLOGY.
CARDIOVASCULAR DISEASE – INVESTIGATION RECOMMENDATIONS
Summary of Literature Review .

INRODUCTION.
In the United States, atherosclerotic cardiovascular disease (CVD) is the leading cause of death for both men and women .

Although improvements in awareness, knowledge, and medications have led to a decrease in death rates, the burden of disease remains very high .

Because atherosclerotic coronary artery disease (CAD) has a long and asymptomatic latent period, it is believed that early targeted preventive measures would be a great benefit to reducing mortality and morbidity.
To identify patients who might benefit from early intervention, it is essential to accurately classify individuals who are asymptomatic but at elevated risk.

CVD prevention has traditionally been based on the assessment of a patient’s conventional risk- factor profile, a combined evaluation based on genetic, social, physiological, and environmental factors .

Risk assessment for CAD is intended to aid in determining the appropriate lifestyle changes and pharmacological interventions to reduce a patient’s risk of cardiac death. A global risk score, such as Framingham, Reynolds, Systematic Coronary Risk Evaluation, or Prospective Cardiovascular Munster, is used to categorize patient risk as low, intermediate, or high.
However, these risk factors are strong population-based markers but poor individual discriminators of CAD disease, and many individuals with 1 or more risk factors do not experience a cardiac event.
There is a growing discordance between the recognized ability of current risk estimation tools to predict outcomes versus that of actual measured outcomes .

Recent imaging advances have made it possible to detect subclinical coronary atherosclerosis.

The coronary artery calcium score (CACS) is a marker of vascular injury that correlates closely with the overall atherosclerotic burden. Individual data derived from this and other imaging tests provide useful prognostic information for patient management and can complement current risk prediction models.

The purpose is to discuss the use of diagnostic imaging tests in asymptomatic patients who are at elevated risk for future cardiovascular events. The assessment goal for these patients is to further refine targeted preventative efforts based on patient risk. Diagnostic imaging tests are used only in asymptomatic patients at elevated cardiovascular risk.

Imaging use in patients who have a known diagnosis of CAD, cardiac symptoms, history of a coronary event, or prior intervention can be found in the following parts of this Chapter. .

The following imaging modalities are available for evaluating asymptomatic patients at elevated risk for CAD: chest radiography, chest fluoroscopy, multi detector computed tomography CT (MDCT), ultrasound (US), magnetic resonance imaging (MRI), cardiac perfusion scintigraphy, echocardiography, and positron emission tomography (PET).

Part 2. follows