Devesa, AnaDelgado, VictoriaValkovic, LadislavLima, Joao A CNagel, EikeIbanez, BorjaRaman, Betty2025-12-172025-12-172025-05-23Circ Res. 2025 May 23;136(11):1454-1475.https://hdl.handle.net/20.500.12105/27072Cardiometabolic diseases encompass a group of conditions characterized by metabolic and inflammatory abnormalities that increase the risk of diabetes and cardiovascular disease. These syndromes involve multiple organs, including the heart, arterial system, brain, skeletal muscle, adipose tissue, hematopoietic system, liver, kidneys, and pancreas. The crosstalk between these organs contributes to the development of disease. Advances in imaging techniques, such as magnetic resonance imaging, magnetic resonance spectroscopy, computed tomography, and positron emission tomography, have revolutionized the evaluation of these conditions. Hybrid imaging modalities, such as positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging, provide unique insights into the anatomy and metabolic alterations occurring in response to cardiometabolic risk factors. These methods are particularly valuable for assessing multisystemic involvement and interorgan crosstalk, revealing critical interactions such as the brain-heart axis, the heart-liver axis, and the fat-muscle-heart dynamics. This review discusses the role of state-of-the-art imaging techniques in evaluating the pathophysiological mechanisms underlying these complex syndromes and the clinical applications of the different imaging techniques in the assessment of cardiometabolic diseases.The Centro Nacional de Investigaciones Cardiovasculares (CNIC) is supported by the Instituto de Salud Carlos III, the Ministerio de Ciencia, Innovación y Universidades (MICIU), and the Pro CNIC Foundation and is a Severo Ochoa Center of Excellence (grant CEX2020-001041-S funded by MICIU/ AEI/10.13039/501100011033). A. Devesa is scientifically supported by the Thrasher Research Fund and acknowledges the support of Sociedad Española de Cardiología (grant SEC/PRS-MOV-INT20/002). B. Ibanez is supported by the European Commission (grants ERC-CoG 819775 and H2020-HEALTH 945118), the Spanish Ministry of Science and Innovation (grant PID2022- 140176OB-I00), the Red Madrileña de Nanomedicina en Imagen MolecularComunidad de Madrid (grant P2022/BMD-7403 RENIM-CM), and a grant from the Novo Nordisk Foundation, REACT. B. Raman is funded by a Wellcome Career Development Award Fellowship (grant 302210/Z/23/Z). E. Nagel receives funding from the German Centre for Cardiovascular Research (DZHK) (grant 81Z0200109). L. Valkovic is funded by a Sir Henry Dale Fellowship supported jointly by the Wellcome Trust and The Royal Society (grant 221805/Z/20/Z) and acknowledges the support of Slovak Grant Agencies VEGA (Vedecka grantova agentura MSVVaM SR a SAV; grant 2/0004/23) and APVV (Agentura na Podporu Vyskumu a Vyvoja; grant 21-0299). B. Raman is also supported by the NIHR Oxford BRC (Multiorgan Imaging Theme).engVoRhttp://creativecommons.org/licenses/by/4.0/acute coronary syndromeatrial fibrillationbone marrowcardiovascular diseasesinsulin resistanceAttribution 4.0 International40403110CIRCULATION RESEARCHopen access