The Role of Advanced Imaging Techniques in Predicting Cardiovascular Outcomes in Asymptomatic Individuals: A Systematic Review and Meta-analysis

Arhum Mahmood

Henry Ford Health System, Detroit, USA.

Enoha El Eraky

St Vincent's University Hospital, Dublin, Ireland.

Ghazala S. Virk *

Avalon University School of Medicine, Ohio, USA.

Muhammad B. Chaudhry

CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.

Manal A. Bhinder

CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.

Ayesha Saleem

Allama Iqbal Medical College, Lahore, Pakistan.

Muhammad Sajawal

Nishtar Medical University, Multan, Pakistan.

Rubela Ray

Bankura Sammilani Medical College, Bankura, India.

Sumaiyya Mohiuddin

Shadan Institute of Medical Sciences, Hyderabad, India.

Muhammad O. Zafar

Dow Medical College, Karachi, Pakistan.

*Author to whom correspondence should be addressed.


Background: Global trends in cardiovascular death have declined and survival rates have decreased over the last 30 years as a result of advancements in medical and interventional therapy.

Objectives: This systematic evaluation and meta-assessment aim to evaluate the predictive efficacy of superior imaging techniques, in particular, CCTA, in asymptomatic people, aiming to elucidate their potential advantages and disadvantages for screening purposes and offer insights into their suitability for risk stratification and control on this populace, informing future scientific recommendations and practices in cardiovascular screening.

Methods: PubMed and Cochrane Library were searched thoroughly for literature search. Ten articles were extracted to be included in this study.

Results: A total of ten studies were included in this systematic review and meta-analysis. All of the included studies were cohorts either retrospective or prospective cohorts. Meta-analysis was performed for two variables that are Cardiovascular Mortality and MACE. Cardiovascular mortality was shown to be improved with the use of Coronary Computed Tomographic Angiography (CCTA). Only one study reported the quantitative effect of CCTA on MACE.

Conclusion: To conclude, our systematic overview and meta-analysis highlight the tremendous position of CCTA in predicting cardiovascular consequences in asymptomatic individuals, suggesting its potential as a precious danger assessment tool for detecting CAD and enhancing cardiovascular mortality prediction, though similar research is wanted to verify its definitive role in medical practice.

Keywords: Cardiovascular disease, asymptomatic patients, artery disease, mortality

How to Cite

Mahmood, Arhum, Enoha El Eraky, Ghazala S. Virk, Muhammad B. Chaudhry, Manal A. Bhinder, Ayesha Saleem, Muhammad Sajawal, Rubela Ray, Sumaiyya Mohiuddin, and Muhammad O. Zafar. 2024. “The Role of Advanced Imaging Techniques in Predicting Cardiovascular Outcomes in Asymptomatic Individuals: A Systematic Review and Meta-Analysis”. Journal of Advances in Medicine and Medical Research 36 (7):104-19.


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Bhatnagar P, Wickramasinghe K, Wilkins E, Townsend N: Trends in the epidemiology of cardiovascular disease in the UK. Heart. 2016;102:1945–52. DOI:10.1136/heartjnl-2016-309573

Timmis A, Townsend N, Gale C, et al.: European society of cardiology: Cardiovascular disease statistics 2017. European Heart Journal. 2017;39:508–79. DOI:10.1093/eurheartj/ehx628

Mahmood SS, Levy D, Vasan RS, Wang TJ: The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014;383: 999–1008. DOI:10.1016/s0140-6736(13)61752-3

Ibrahim Al-Irr K. Complicated coronary artery angiography with transient cortical blindness. Cardiol. Angiol. Int. J. [Internet]. 2016 Apr. 23 [cited 2024 May 24];5(2):1-6. Available:

Nwafor CE, Agbamoro J. Clinical Characteristics and Temporal Profile of Patients Referred to a Cardiac Centre for Stress Electrocardiography (ECG) in Southern Nigeria. Asian J. Med. Health. [Internet]. 2024 Apr. 10 [cited 2024 May 24];22(6):37-45.


Garrone P, Biondi‐Zoccai GI, Salvetti I, Sina N, Sheiban I, Stella PR, Agostoni P. Quantitative coronary angiography in the current era: Principles and applications. Journal of interventional cardiology. 2009 Dec;22(6):527-36.

Degrell P, Sorbets E, Feldman LJ, Steg PG, Ducrocq G: Screening for coronary artery disease in asymptomatic individuals: Why and how? Archives of Cardiovascular Diseases. 2015;108:675–82.


Lin E, Hwang W: Imaging assessment of cardiovascular risk in asymptomatic adults. American Journal of Roentgenology. 2011; 197:W1046–51. DOI:10.2214/ajr.11.6758

Greenland P, Bonow RO, Brundage BH, et al.: ACCF/AHA 2007 Clinical Expert Consensus Document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Journal of the American College of Cardiology. 2007, 49:378–402. DOI:10.1016/j.jacc.2006.10.001

Lloyd-Jones D, Adams RJ, Brown TM, et al.: Heart disease and stroke statistics—2010 update. Circulation. 2010;121. 10.1161/circulationaha.109.192667

Williams MC, Hunter A, Shah ASV, et al. Use of coronary computed tomographic angiography to guide management of patients with coronary disease. Journal of the American College of Cardiology. 2016;67:1759–68. DOI:10.1016/j.jacc.2016.02.026

Coronary CT angiography and 5-Year risk of myocardial infarction. New England Journal of Medicine/the New England Journal of Medicine. 2018;379:924–33. DOI:10.1056/nejmoa1805971

Hoffmann U, Ferencik M, Udelson JE, et al. Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain. Circulation. 2017;35: 2320–32. DOI:10.1161/circulationaha.116.024360

Knuuti J, Wijns W, Saraste A, et al.: 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2019; 41:407–77. DOI:10.1093/eurheartj/ehz425

Poon M, Lesser JR, Biga C, et al.: Current Evidence and Recommendations for Coronary CTA First in evaluation of stable coronary artery Disease. Journal of the American College of Cardiology. 2020, 76:1358–62. DOI:10.1016/j.jacc.2020.06.078

Moss AJ, Williams MC, Newby DE, Nicol ED: The updated NICE guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease. Current Cardiovascular Imaging Reports. 2017;10(10). DOI:1007/s12410-017-9412-6

Cho I, Chang H-J, Sung JM, et al. Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the confirm registry (coronary ct angiography evaluation for clinical outcomes: An International Multicenter Registry). Circulation. 2012;126:304–13. DOI:10.1161/circulationaha.111.081380

Meinel FG, Renker M. Coronary CT angiography for screening, risk stratification, and management of asymptomatic patients: State of the evidence. In: Contemporary medical imaging. 2019;739–45. DOI:10.1007/978-1-60327-237-7_58

Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews. 2022;18: e1230. Available:

Moon SJ, Chun EJ, Yoon YE, Park KS, Jang HC, Lim S: Long‐Term prognostic value of coronary computed tomography angiography in an asymptomatic elderly population. Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease. 2019;8. DOI:10.1161/jaha.119.013523

Limpijankit T, Jongjirasiri S, Meemook K, Unwanatham N, Rattanasiri S, Thakkinstian A, Laothamatas J. Impact of coronary CT angiography in selection of treatment modalities and subsequent cardiovascular events in Thai patients with stable CAD. Clinical Research in Cardiology. 2023;113:433–45. DOI:10.1007/s00392-023-02313-1

Ng M-Y, Zhou W, Vardhanabhuti V, et al. Cardiac magnetic resonance for asymptomatic patients with type 2 diabetes and cardiovascular high risk (CATCH): A pilot study. Cardiovascular Diabetology. 2020;19. DOI:10.1186/s12933-020-01019-2

Kuznetsova T, Cauwenberghs N, Sabovčik F, Kobayashi Y, Haddad F: Evaluation of diastole by echocardiography for detecting early cardiac dysfunction: an outcome study. ESC Heart Failure. 2022, 9:1775–83. DOI:10.1002/ehf2.13863

Warren J, Ellims A, Bloom J, et al. Mixed plaque on coronary CT angiography predicts atherosclerotic events in asymptomatic intermediate-risk individuals. Open Heart. 2024;11: e002609. DOI:10.1136/openhrt-2024-002609

Low S, Chua H-R, Wong R, Goh A, Ng Y-H, Teo B-W, Vathsala A. Myocardial ischemia by radionuclide imaging and long-term outcomes after kidney transplantation. International Urology and Nephrology. 2020;52:1995–2003.


Cho MS, Roh J, Park H, et al. Practice pattern, diagnostic yield, and Long‐Term prognostic impact of coronary computed tomographic angiography. Journal of the American Heart Association Cardiovascular and Cerebrovascular Disease. 2020;9.


Le T-T, Bryant JA, Ang BWY, et al. The application of exercise stress cardiovascular magnetic resonance in patients with suspected dilated cardiomyopathy. Journal of Cardiovascular Magnetic Resonance. 2020;22. DOI:10.1186/s12968-020-0598-4

Yoon SH, Kim E, Jeon Y, et al. Prognostic value of coronary ct angiography for predicting poor cardiac outcome in stroke patients without known cardiac disease or chest pain: The assessment of coronary artery disease in stroke patients study. Korean Journal of Radiology/Korean Journal of Radiology. 2020, 21:1055. DOI:10.3348/kjr.2020.0103

Pickhardt PJ, Graffy PM, Zea R, Lee SJ, Liu J, Sandfort V, Summers RM. Automated CT biomarkers for opportunistic prediction of future cardiovascular events and mortality in an asymptomatic screening population: A retrospective cohort study. the Lancet Digital Health. 2020;2:e192–200. DOI:10.1016/s2589-7500(20)30025-x

Lamers MMH, van Oijen MGH, Pronk M, Drenth JPH. Treatment options for autoimmune hepatitis: A systematic review of randomized controlled trials. Journal of Hepatology. 2010 Jul;53(1):191–8. Available:

Perone F, Bernardi M, Redheuil A, et al. Role of cardiovascular imaging in risk assessment: recent advances, gaps in evidence, and future directions. Journal of Clinical Medicine. 2023;12:5563. DOI:10.3390/jcm12175563

Romero-Cabrera JL, Ankeny J, Fernández-Montero A, Kales SN, Smith DL. A Systematic review and meta-analysis of advanced biomarkers for predicting incident cardiovascular disease among asymptomatic middle-aged adults. International Journal of Molecular Sciences. 2022;23:13540. DOI:10.3390/ijms232113540