Takotsubo syndrome (TS) is characterized by transient left ventricular dysfunction accompanied by dynamic changes in myocardial tissue; however, differences in cardiac magnetic resonance (CMR) findings across disease phases remain incompletely characterized, particularly in large multicenter cohorts. This retrospective analysis from the multicenter EVOLUTION registry included 439 consecutive patients with TS (400 females; mean age 70.01 ± 11.59 years), stratified according to the time from symptom onset to CMR into acute (1 to 72 hours), subacute (4 to 21 days), and late (≥22 days) acquisition groups. Among these, 146 (33%) were classified as acute, 266 (60%) as subacute, and 27 (6%) as late. Biventricular systolic function was higher in patients imaged at later time points (both p = 0.001). Myocardial edema and late gadolinium enhancement (LGE) were more prevalent and extensive in patients imaged earlier and less evident in those imaged later. In multivariable analysis, T2-mapping Z-score and LGE extent were independently associated with earlier timing of CMR. T2-mapping Z-score decreased by approximately 0.22 units per day, corresponding to an average relative decline of 3% to 4% per day. In conclusion, cross-sectional CMR assessment in TS demonstrates that patients imaged at later time points exhibit more preserved systolic function and lower prevalence of myocardial edema and LGE, supporting the dynamic and reversible nature of myocardial injury in this condition; however, longitudinal studies with serial imaging are needed to confirm these findings.

PURPOSE:The aim of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3DTEE) versus two-dimensional transesophageal echocardiography (2DTEE) in the detection of prosthetic valve endocarditis (PVE), its prognostic value, and its peculiar diagnostic features compared to native valve endocarditis (NVE). METHODS:One hundred and twenty-nine patients with infective endocarditis (64 PVE and 65 NVE), selected from a population of one hundred and ninety-five patients with suspected PVE or NVE, were studied using 3DTEE and 2DTEE. Presence, location and size of vegetations, new or progressive valve regurgitation, perivalvular extension, and new dehiscence of valve prosthesis were assessed. RESULTS:A definite diagnosis of infective endocarditis was obtained by using 2023 Duke-ESC criteria. Significant improvement in global χ2 value was noted with the addition of 3DTEE parameters compared with 2DTEE alone for PVE detection (from 81.7 to 92.3, p=0.002) and for prediction of in-hospital mortality (from 79.3 to 86.7, p=0.01). In patients with prosthetic valves and surgical confirmation of the diagnosis, 2DTEE and 3DTEE showed a sensitivity of 84.8% and 90.1%, a specificity of 74.2% and 84.3% (p=0.001), a positive predictive value of 89.6% and 93.4%, and a negative predictive value of 76.3% and 85.6% (p=0.003) for PVE detection. Regarding the detection of PVE- and NVE-related valvular and perivalvular lesions according to surgery findings, Receiver Operating Characteristic (ROC) curve analysis showed similar diagnostic performance of three-dimensional transesophageal echocardiography (3DTEE) for valvular complications (AUC = 0.727 vs. 0.897, p = 0.704) and superior diagnostic performance for perivalvular complications, both in mechanical and biological prostheses (AUC = 0.831 vs. 0.516, p = 0.012, and AUC = 0.836 vs. 0.697, p = 0.026, respectively). These results were particularly marked in early PVE compared to late PVE (AUC = 0.883 vs. 0.478, p = 0.001). CONCLUSIONS:Our results suggest that 3DTEE provides additional diagnostic and prognostic information for patients with PVE and higher diagnostic performance for perivalvular complications compared to NVE.

BACKGROUND. Late gadolinium enhancement (LGE) has traditionally been considered absent in Takotsubo syndrome (TS). However, accumulating evidence indicates the finding's presence during the acute phase in a subset of patients. OBJECTIVE. The purpose of this study was to evaluate the frequency of LGE, identify factors associated with LGE presence, assess prognostic implications of LGE, and compare methods for quantifying LGE extent, in patients with TS undergoing cardiac MRI. METHODS. This retrospective study included 370 patients (338 women and 42 men; mean age 69.7 ± 12.0 [SD] years) from the nine-center EVOLUTION (Exploring the Evolution in Prognostic Capability of Multi-Sequence Cardiac Magnetic Resonance in Patients Affected by Takotsubo Cardiomyopathy) registry from November 21, 2007, to December 22, 2024. The registry included patients with hospital admission for TS who underwent cardiac MRI within 10 days after symptom onset; patients were required to fulfill professional society criteria for TS diagnosis. Two radiologists independently reviewed LGE images to assess examinations for the visual presence of LGE, resolving discrepancies for further analyses. In patients with LGE, a radiologist quantified LGE extent visually and using semiautomated methods (2-SD, 3-SD, and 5-SD threshold methods relative to remote myocardial signal intensity; full width at half-maximum method relative to LGE peak signal intensity). In-hospital adverse events (death or major cardiac or cerebrovascular events) were identified. RESULTS. The two radiologists identified LGE in 58 (15.7%) and 54 (14.6%) patients; by consensus, LGE was present in 58 (15.7%) patients. In multivariable analysis, LGE presence was independently associated with a shorter interval from symptom onset to cardiac MRI (OR per day = 0.81; p = .003) and a greater extent of myocardial edema on T2-weighted STIR images (OR per segment = 1.44; p < .001). The mean LGE extent by visual assessment was 25.5%. Among semiautomated methods, correlation with visual assessment of LGE extent was greatest for the 2-SD threshold method (ρ = 0.93). In-hospital adverse events occurred in 88 (23.8%) patients and were not significantly associated with LGE presence (p = .44) or extent by any method (all p > .05). CONCLUSION. LGE was identified in 15.7% of patients with TS and showed significant independent associations with greater myocardial edema extent and earlier MRI timing after presentation but was not associated with in-hospital adverse events. CLINICAL IMPACT. The results may provide useful context when radiologists encounter LGE on cardiac MRI in patients with TS.

BACKGROUND:The pathogenesis of Takotsubo syndrome (TTS) is poorly understood, but differences in outcome depending on the triggering factor imply differences in the pathophysiology. Beyond the established trigger-based InterTAK (International Takotsubo Registry) classification, the newly proposed distinction between primary and secondary TTS aims to differentiate emotionally primed heart dysfunction from TTS driven by direct myocardial injury. To explore these potential differences, we utilized cardiovascular magnetic resonance imaging to assess left ventricular function, myocardial edema, and myocardial injury across the InterTAK classification and between primary and secondary TTS. METHODS:For this multicenter cohort study, 110 patients (95% women, age 66±12 years) from the InterTAK registry were included who received cardiovascular magnetic resonance 3 (interquartile range, 2-5) days after symptom onset. Cardiovascular magnetic resonance included assessment of myocardial function, edema (T2-weighted spin-echo and T2-mapping when available), and late gadolinium enhancement. RESULTS:No significant differences were observed in left ventricular volumes, function, or mass across the 3 InterTAK groups or between primary and secondary TTS. Patients with emotional triggers exhibited significantly larger myocardial edema (72% versus 60% for physical triggers; P<0.01), supported by higher T2-mapping values in a subset of 22 patients with T2-mapping. In multivariable regression, only emotional trigger (P<0.01) and the absence of coronary artery disease (P=0.04) were independently associated with the extent of myocardial edema. Secondary TTS showed a higher prevalence of focal or patchy late gadolinium enhancement (primary 19%, secondary 54%; P<0.01). In multivariable logistic regression, secondary TTS (P<0.01) and early cardiovascular magnetic resonance (P=0.02) were associated with the presence of any late gadolinium enhancement. CONCLUSIONS:TTS due to emotional stress is associated with larger myocardial edema, and secondary TTS exhibited late gadolinium enhancement more frequently, indicative of direct myocardial damage. These findings suggest that emotionally primed heart dysfunction and direct myocardial injury contribute to TTS pathophysiology to varying extents, influenced by both the triggering factor and preexisting conditions.

Ventricular tachycardia following myocardial infarction is often sustained by complex reentrant circuits that are challenging to characterize and treat using conventional electroanatomical mapping. Computational modeling provides a powerful complementary approach to understanding conduction pathway dynamics more effectively and supporting ablation strategies. Here, we present a reproducible and data-driven clinically guided computational framework for the retrospective analysis of post-infarction ventricular tachycardia and ablation procedures. The method integrates patient-specific electroanatomical mapping data—including local activation times, voltage maps, and electrograms—to build a personalized model that captures both structural and functional remodeling via a viability-based scalar field. A novel calibration procedure is introduced to locally estimate tissue conductivity, enabling accurate reproduction of observed activation patterns. The model is used to simulate arrhythmia inducibility and sustainability, and to retrospectively evaluate the impact of clinical radiofrequency ablation, accounting for lesion size and transmurality. In silico exploration of alternative ablation strategies is also performed to minimize lesion volume while maintaining arrhythmia suppression. The entire workflow is designed for rapid execution using a GPU-accelerated monodomain solver and is fully compatible with existing clinical practices, offering a practical tool for substrate interpretation and patient-specific ablation planning.

BACKGROUND:Prognostic relevance of cardiac magnetic resonance (CMR) in takotsubo syndrome (TTS) is not fully elucidated. We aimed to assess the prognostic value of CMR-derived left ventricular stroke volume indexed (LVSVi) in patients with TTS. METHODS:Consecutive patients with TTS underwent CMR at median 5 days (3-7) after admission. CMR analysis was centralised, patients were categorised by LVSVi (<35 vs ≥35 mL/m²). Median follow-up was 360 days. Primary endpoint was a composite of major adverse cardiovascular events and all-cause-death, secondary endpoint was all-cause-death. RESULTS:This observational study included 376 patients (mean age 70±11 years; 9% male). Average left ventricular ejection fraction (LVEF) on admission was 43%, increasing to 48% at CMR imaging. 172 (46%) patients had CMR-derived LVSVi <35 mL/m²; these were older and showed higher prevalence of hypertension and dyspnoea and a lower LVEF at admission. On CMR, low LVSVi patients demonstrated smaller LV end-diastolic volumes, lower biventricular systolic function and larger myocardial oedema. Kaplan-Meier analyses showed higher primary and secondary endpoint rates in the low-LVSVi group (both log-rank p<0.01) and lowest event rates in patients having both high LVSVi and normal LVEF (both log-rank p<0.01). Multivariable Cox-regression analysis identified LVSVi as an independent predictor of both the primary (HR 0.96; 95% CI 0.92 to 0.98) and secondary (HR 0.95; 95% CI 0.90 to 0.99) endpoint. CONCLUSIONS:Early CMR after admission in patients with TTS highlights recovering LVEF with relatively low LVSVi. Low LVSVi independently predicted mid-term outcomes, and the presence of both high LVSVi and recovered LVEF identified a low-risk subgroup.

Myocarditis is a common disease with a risk of chronic progression. The aim of this study is to assess changes in MRI parameters during serial monitoring in patients with acute myocarditis (AM), and to evaluate their prognostic implications for the prediction of major adverse cardiac events (MACE). In this prospective multicenter study, patients with MRI-confirmed AM between 2016 and 2020 underwent serial MRI: at baseline (6 [interquartile range (IQR), 3–10] days after symptom onset), short-term (median 36 [IQR, 33–42] days) and long-term (392 [IQR, 358–435] days). Cardiac MRI parameters, including mapping, were evaluated. MACE at 5-year follow-up were collected. A total of 105 patients (age 38 [IQR, 28–45 years]; men 75, 71

Background: Cancer affects patients far beyond the physical burden of disease. Emotional distress, uncertainty, existential suffering, and unmet spiritual needs frequently accompany diagnosis, treatment, survivorship, and end-of-life care. In Ayurveda, Daivavyapashraya Chikitsa refers to spiritually oriented measures such as mantra, observances, ritual, fasting, and faith-based reassurance. Although this framework is well described in classical Ayurvedic thought, its role in modern oncology remains insufficiently defined. Objective: To examine the potential supportive role of Daivavyapashraya Chikitsa in cancer care through an evidence-informed review of Ayurvedic scholarship, spiritual care literature, and integrative oncology research. Methods: A focused narrative review was conducted using PubMed/PubMed Central and authoritative oncology sources. Priority was given to English-language reviews, clinical guidelines, randomized controlled trials, meta-analyses, and major scholarly articles relevant to Ayurveda, spiritual care, meaning-centered interventions, mind-body practices, and mantra/mantram-based approaches in cancer care. Results: Direct oncology-specific evidence on Daivavyapashraya Chikitsa is limited. However, adjacent evidence suggests that spiritually oriented and mind-body interventions may improve anxiety, depression, distress, fatigue, spiritual well-being, and quality of life in patients with cancer. Meta-analyses support modest benefits of psychosocial and spiritual interventions on spiritual well-being, while recent guidelines from the Society for Integrative Oncology and ASCO support selected non-pharmacological interventions for anxiety and depression in cancer settings. Mantra/mantram-based practices appear feasible and potentially beneficial in survivorship settings, although oncology-specific data remain preliminary. Conclusion: Daivavyapashraya Chikitsa should not be presented as a proven anticancer treatment. Rather, it may be understood as a traditional Ayurvedic framework for addressing spiritual and existential suffering within supportive oncology. Its most appropriate contemporary role is as a complementary, patient-centered, culturally sensitive supportive approach, used alongside standard cancer treatment. More rigorous oncology-specific research is needed.

Native T1 mapping with cardiac MRI is an effective biomarker of glycosphingolipid accumulation in patients with Fabry disease cardiomyopathy; this study highlights its potential utility in disease monitoring and severity stratification.

BACKGROUND Myocarditis is an inflammatory disease of the myocardium with a highly variable clinical presentation and is often triggered by viral infections. While corticosteroids have historically been used with caution in viral myocarditis due to concerns over impaired viral clearance, recent insights from the coronavirus disease 2019 pandemic suggest that their use may offer clinical benefits in selected cases. Whether such benefits extend to other viral etiologies, including influenza, remains uncertain. We report a case of recurrent viral myocarditis in a young woman, initially following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and later associated with influenza A (H1N1), illustrating diagnostic and therapeutic challenges. CASE SUMMARY A previously healthy 27-year-old woman presented with fulminant myocarditis after a paucisymptomatic SARS-CoV-2 infection. The initial episode was characterized by pericardial effusion, rapidly progressing to cardiogenic shock and severe left ventricular dysfunction, requiring veno-arterial extracorporeal membrane oxygenation. Empirical high-dose corticosteroid therapy, remdesivir, and monoclonal anti-SARS-CoV-2 antibodies led to complete recovery of cardiac function. Two years later, the patient developed recurrent myocarditis triggered by H1N1, presenting with chest pain, elevated cardiac biomarkers, and severe reduction in ejection fraction. Cardiac magnetic resonance confirmed acute myocarditis with severe left ventricular dysfunction. High-dose corticosteroids and levosimendan were administered, resulting in progressive improvement without the need for mechanical support. At discharge, following both episodes, the patient was asymptomatic and had a complete recovery of the left ventricular ejection fraction. Genetic testing was performed to investigate possible predisposition. CONCLUSION This case highlights the diagnostic and therapeutic challenges of recurrent viral myocarditis, as well as the potential role of immunosuppression.

Abstract Objective Fabry disease cardiomyopathy (FD-CM) is a genetic disorder induced by glycosphingolipid accumulation (GSL-A) in cardiac cells, resulting in left ventricular hypertrophy (LVH) and contractile impairment. Native T1 (nT1) mapping by cardiac magnetic resonance (CMR) effectively detects myocardial GSL-A in patients with FD-CM. However, the association between nT1 values and GSL-A severity has not been histologically confirmed. This study aims to assess the capability of nT1 to classify GSL-A burden, using endomyocardial biopsy (EMB) as the reference, and to identify the best matching site for nT1 measurement. Materials and methods Forty FD-CM subjects undergone CMR and EMB were classified into 4 groups according to GSL-A severity. CMRs were performed using a comprehensive protocol including nT1 and T2 mapping sequences. Global, per-plane, and septal segmental myocardial nT1 and T2 values (excluding late gadolinium enhanced areas) were compared among groups. Correlations between nT1 values, GSL-A and LVH were explored. Statistical analyses used distribution-appropriate tests, including group comparisons, correlation, and ROC analyses. Results Significant nT1 differences emerged among groups at all measurement sites, with significant negative correlations with GSL-A, particularly in AHA segment 9, the mid-interventricular septum region of interest and midventricular plane (r = −0.741; −0.716; −0.715; p < 0.001). nT1 measured at these locations demonstrated excellent diagnostic accuracy in identifying severe GSL-A (area under the curve: 0.860, 0.903, and 0.895, respectively). Conclusion Myocardial nT1 values strongly correlate with GSL-A, with midventricular septum measurements providing the best agreement. If supported by further studies, CMR could act as a noninvasive tool for disease staging and risk stratification, helping to identify patients in advanced, higher-risk stages. Critical relevance statement Native T1 mapping correlates closely with histological glycosphingolipid accumulation in Fabry cardiomyopathy. This noninvasive biomarker may support early disease stratification and guide timely therapeutic intervention. Key Points Native T1 values are a valid biomarker of glycosphingolipid accumulation in myocardial tissue and correlate with accumulation degree. Midventricular interventricular septum is the preferred site for nT1 measurement, showing the best agreement with glycosphingolipid accumulation at endomyocardial biopsy. The use of native T1 in the setting of suspected cardiac Fabry disease will help to stratify disease severity, without the intrinsic risk of endomyocardial biopsy. Graphical Abstract

BACKGROUND:Physical triggers (PT) are increasingly recognized as important determinants of outcomes in Takotsubo syndrome (TS). This multicenter study investigated the prevalence, clinical features, cardiovascular magnetic resonance (CMR) findings, and prognostic impact of PT in patients with TS. METHODS AND RESULTS:In this retrospective registry, 399 TS patients (mean age 70.1 ± 11.8 years, 91% female) were included with a median follow-up of 26.7 months. A PT was identified in 30.5% of cases, an emotional trigger in 38.8%, and no trigger in 30.5%. Patients with PT showed higher C-reactive protein levels (P = 0.008), lower troponin values (P = 0.018), less frequent and less extensive T2-STIR abnormalities (P = 0.007 and P = 0.005, respectively) and LGE (P = 0.002 and P = 0.005, respectively), longer hospital stays (P = 0.002), and more frequent in-hospital complications (P = 0.001). Kaplan-Meier analysis demonstrated significantly lower event-free survival in the PT group compared with patients in the emotional or no-trigger groups (log-rank P = 0.003). In multivariable Cox regression analysis, the presence of a physical trigger (P = 0.037) and pre-existing neurological disease (P = 0.027) were independently associated with a higher risk of all-cause mortality and post-discharge adverse events. CONCLUSION:TS patients with PT represent a high-risk subgroup with worse in-hospital outcomes and increased post-discharge events. Careful identification of the trigger type may therefore help stratify risk, allowing for closer monitoring during hospitalization and more vigilant long-term management in the outpatient setting.

Purpose To evaluate the prevalence, clinical correlates, and long-term prognostic impact of right ventricular (RV) impairment at cardiac MRI in patients with Takotsubo syndrome (TS). Materials and Methods Patients with TS were included in this secondary analysis of the Exploring the eVolution in PrognOstic capabiLity of mUltisequence Cardiac MagneTIc ResOnance in patieNts Affected by Takotsubo Cardiomyopathy (EVOLUTION) registry (ClinicalTrials.gov identifier no. NCT06277297) (November 2007-December 2024). RV impairment was defined as an RV ejection fraction <44% in male patients and <47% in female patients at cardiac MRI. Median follow-up was 13 months (IQR, 2.2-37 months). The primary end point was a composite of death due to any cause and major cardiovascular or cerebrovascular adverse events. Event-free survival was evaluated using Kaplan-Meier estimates, and univariable and multivariable Cox regression analysis identified predictors of the primary end point. Results Overall, 419 patients with TS (mean age, 69.9 years ± 12 [SD]; 383 female) were included. RV impairment was observed in 18.1% (76 of 419) of patients. Patients with RV impairment had longer hospitalization (13.7 days ± 20.5 vs 9.0 days ± 5.8, P = .016) and lower left ventricular ejection fraction (34.6% vs 50.3%, P = .001) and less frequently had emotional triggers (29% vs 42%, P = .026). RV impairment was associated with increased incidence of in-hospital (32% vs 18%, P = .005) and out-of-hospital complications (30% vs 15%, P = .001). Event-free survival was lower in patients with RV impairment (log-rank, P < .001). RV impairment (hazard ratio, 1.88 [95% CI: 1.20, 2.92]; P = .005) emerged as an independent predictor of the primary end point. Conclusion In patients with TS, the presence of RV impairment identified a high-risk subgroup with worse clinical course and increased risk of in-hospital and long-term complications. Keywords: MR Imaging, Cardiac, Volume Analysis, Takotsubo Syndrome, Cardiovascular Magnetic Resonance, Right Ventricle, Prognosis ClinicalTrials.gov identifier no. NCT06277297 Supplemental material is available for this article. © RSNA, 2026.

Transthyretin cardiac amyloidosis (ATTR-CA) leads to myocardial infiltration, affecting prognosis and survival. Diagnosing early-stage ATTR-CA remains challenging due to its subtle manifestations. This study investigates subclinical myocardial alterations in asymptomatic ATTR mutation carriers (ATTR-MC) using advanced cardiac magnetic resonance (CMR) techniques, including T1 mapping and myocardial strain analysis. A retrospective cohort of 60 subjects was analyzed, comprising 20 ATTR-CA patients, 20 asymptomatic ATTR-MC, and 20 controls. Standard CMR parameters were compared alongside myocardial strain analysis. Results indicated that despite preserved ejection fraction and myocardial morphology, ATTR-MC exhibited significantly impaired left ventricular global longitudinal strain (LV GLS), left atrial reservoir, conduit, and booster pump strain (LA RS, CS, and BPS) compared to controls. However, native T1 and extracellular volume (ECV) values remained within normal ranges, distinguishing early dysfunction from overt amyloid deposition seen in ATTR-CA. These findings suggest that myocardial strain analysis could serve as an early biomarker for subclinical ATTR-CA, offering a potential target for selecting patients who may benefit from early intervention. Implementing CMR-derived strain parameters in clinical practice may improve risk stratification and timely therapeutic decisions in ATTR-MC.

Coronary CT angiography is widely implemented, with an estimated 2.2 million procedures in patients with stable chest pain every year in Europe alone. In parallel, artificial intelligence and machine learning are poised to transform coronary atherosclerotic plaque evaluation by improving reliability and speed. However, little is known about how to use coronary atherosclerosis imaging biomarkers to individualize recommendations for medical treatment. This Consensus Statement from the Quantitative Cardiovascular Imaging (QCI) Study Group outlines key recommendations derived from a three-step Delphi process that took place after the third international QCI Study Group meeting in September 2024. Experts from various fields of cardiovascular imaging agreed on the use of age-adjusted and gender-adjusted percentile curves, based on coronary plaque data from the DISCHARGE and SCOT-HEART trials. Two key issues were addressed: the need to harness the reliability and precision of artificial intelligence and machine learning tools and to tailor treatment on the basis of individualized plaque analysis. The QCI Study Group recommends that the presence of any atherosclerotic plaque should lead to a recommendation of pharmacological treatment, whereas the 70th percentile of total plaque volume warrants high-intensity treatment. The aim of these recommendations is to lay the groundwork for future trials and to unlock the potential of coronary CT angiography to improve patient outcomes globally. This expert Consensus Statement from the Quantitative Cardiovascular Imaging Study Group provides evidence-based recommendations for integrating coronary CT angiography and artificial intelligence-supported evaluation of atherosclerotic plaque in patients with stable chest pain. The authors aim to harness the reliability and precision of artificial intelligence to individualize treatment based on atherosclerotic plaque analysis.

AIMS:Despite the promising results, the clinical implications of the CCT-FFR is already debated. This metanalysis aimed to determine the potential benefits of incorporating FFRCT into stable CAD management. METHODS:After searching for studies comparing outcomes of patients with suspected stable CAD who underwent CCT-FFR as a first strategy versus non-urgent cardiovascular testing after a clinical judgment, we calculated odds ratios (ORs) and 95 ​% confidence intervals (CIs) using a random-effects or fixed-effects meta-analysis model depending on heterogeneity significance. RESULTS:5 studies (3 RCTs and 2 observational studies) globally encompassing 5282 patients (CCT-FFR ​= ​2604 patients, Control Group ​= ​2678 patients) were included in the quantitative analysis. The rates of ICA overall (OR 1.57, 95%CI 1.36-1.81, p value ​< ​0.001) and those without obstructive CAD (OR 6.63, 95%CI 4.79-9.16, p value ​< ​0.001) were reduced in the CCTAFFR group, as compared to the control group. Moreover, CCT-FFR patients underwent coronary revascularization more frequently than patients in the control arm (OR 0.48,CI 0.38-0.62, p value ​< ​0.001). There was no significance difference between the two strategies in terms of 1 year MACE (OR 1.11,CI 0.86-1.44, p value 0.42), nonfatal MI (OR 0.73, CI 0.41-1.33, p value 0.31), all-cause mortality (OR 1.29,CI 0.47-3.54, p value 0.63) and unplanned revascularization for angina (OR 0.99, 95%CI 0.65-1.49, p value 0.95). CONCLUSIONS:In conclusion, in the management of stable CAD, the use of CCT-FFR was associated with lower overall rates of ICA but higher rates of coronary revascularization with comparable 1-year clinical impact.

Technetium-99m bone scintigraphy has revolutionized the non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) and markedly increased disease recognition. Although this technique should ideally be applied in patients with a high pre-test probability of ATTR-CM, its use in other clinical settings may reveal incidental pathological myocardial uptake that prompts referral to specialized centers even in the absence of typical red flags. In such cases, where confounding factors such as left ventricular hypertrophy from alternative causes may coexist, awareness of potential pitfalls and the integration of scintigraphic findings with clinical features, biomarkers, and echocardiographic data are essential to avoid misdiagnosis and inappropriate therapy. Cardiac magnetic resonance (CMR) imaging provides a crucial complementary role, offering refined tissue characterization, improved differential diagnosis, and valuable prognostic insights. A combined approach that situates scintigraphy within the broader clinical context and incorporates CMR in ambiguous cases is fundamental to ensure an accurate diagnosis and optimal patient management.