The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging-guided precisi
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CARDIAC RADIOLOGY
The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging‑guided precision medicine Antonio Esposito1,2 · Guglielmo Gallone3 · Anna Palmisano1,2 · Livia Marchitelli4 · Federica Catapano4 · Marco Francone4 Received: 18 June 2020 / Accepted: 3 September 2020 / Published online: 22 September 2020 © The Author(s) 2020
Abstract The purpose of this article is to provide an overview on the role of CT scan and MRI according to selected guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/ AHA). ESC and ACC/AHA guidelines were systematically reviewed for recommendations to CT and MRI use in specific cardiovascular (CV) clinical categories. All recommendations were collected in a dataset, including the class of recommendation, the level of evidence (LOE), the specific imaging technique, the clinical purpose of the recommendation and the recommending Society. Among the 43 included guidelines (ESC: n = 18, ACC/AHA: n = 25), 26 (60.4%) contained recommendations for CT scan or MRI (146 recommendations: 62 for CT and 84 for MRI). Class of recommendation IIa (32.9%) was the most represented, followed by I (28.1%), IIb (24%) and III (11.9%). MRI recommendations more frequently being of higher class (I: 36.9%, IIa: 29.8%, IIb: 21.4%, III: 11.9%) as compared to CT (I: 16.1%, IIa: 37.1%, IIb: 27.4%, III: 19.4%). Most of recommendation (55.5%) were based on expert opinion (LOE C). The use of cardiac CT and cardiac MR in the risk assessment, diagnosis, therapeutic and procedural planning is in continuous development, driven by an increasing need to evolve toward an imaging-guided precision medicine, combined with cost-effectiveness and healthcare sustainability. These developments must be accompanied by an increased availability of high-performance scanners in healthcare facilities and should emphasize the need of increasing the number of radiologists fully trained in cardiac imaging. Keywords AHA/ACC guidelines · ESC guidelines · Cardiovascular magnetic resonance · Cardiac computed tomography angiography
Introduction
* Marco Francone [email protected] 1
Experimental Imaging Center, Radiology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
2
School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
3
Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
4
Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
Non-invasive cardiovascular imaging with computed tomography (CT) and magnetic resonance imaging (MRI) has become integral part of the clinical routine, following the extraordinary technical evolution of the last 10–15 years. Along with molecular and genomic studies, the recognized importance of cardiac imaging in early disease phenotyping, risk st
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