Ruolo dei marcatori di danno d'organo subclinico nella stratificazione del rischio cardiovascolare: dall'imaging alle alterazioni funzionali

Global cardiovascular (CV) risk estimation represents the first line approach in CV risk assessment. However, although this approach is widely used and recommended by international guidelines, it shows important limitations. Thus, ultrasonographic (US) detection of left ventricular hypertrophy (LVH) and carotid atherosclerosis (ATS) has became crucial in CV risk stratification. Similarly, functional abnormalities of the large arteries as investigated by carotid applanation tonometry (CAT) have emerged as alternative prognostic markers.In different studies we demonstrated that both LVH and carotid ATS significantly improves CV risk prediction, but carotid US has to be preferred as first line examination in CV risk stratification.Moreover, the persistence or new development of structural organ damage significantly increases the risk of future CV events. However, although the prognostic importance of US techniques in CV risk assessment, they can hardly be extended to the whole population of subjects at risk for economic reasons. CAT is a “new” technique that has demonstrated to improve CV events prediction similarly to cardiac and carotid US. Moreover, CAT shows high sensitivity for organ damage and high negative predictive value for CV events. Thus, an alterated CAT strongly reflects structural organ damage, while a normal exam would exclude further more expensive investigations. Thus, CAT could be a useful screening tool for wide populations of subjects at risk.