Background: HyperDoppler is a new echocardiographic color Doppler-based technique that can assess intracardiac flow dynamics. The aim of this study was to verify the feasibility and reproducibility of this technique in unselected patients and its capability to differentiate measures of vortex flow within the left ventricle (LV) in normal sedentary subjects, athletes, and patients with heart failure. Methods: Two hundred unselected, consecutive patients presenting at the echocardiographic laboratory, 50 normal subjects, 30 athletes, and 50 patients with chronic heart failure and LV ejection fraction <50% were enrolled. Images were acquired using a MyLab X8 echo-scanner. Area, intensity, depth, length, and kinetic energy dissipation (KED) of vortex flow were measured. Results: The HyperDoppler technique feasibility was 94.5%. According to the intraclass correlation coefficient evaluations, repeatability and reproducibility of vortex flow measures were good for vortex area (0.82, 0.85), length (0.83, 0.82), and depth (0.87, 0.84) and excellent for intensity (0.92, 0.90) and KED (0.98, 0.98). Combining different vortex flow measures, the LV flow profile of healthy sedentary individuals, athletes, and heart failure patients could be differentiated. Conclusions: HyperDoppler is a feasible, reliable, and practical technique for the assessment of LV flow dynamics and may distinguish normal subjects and patients with heart failure.

Subclinical coronary atherosclerosis is common but its biological aggressiveness and interplay with extracoronary disease in asymptomatic individuals remain unclear. We evaluated the prevalence of high-risk coronary plaques (HRPs) and their relationship with mild carotid atherosclerosis and coronary calcium in a cardiovascular (CV) high-risk cohort in primary prevention. This retrospective multicenter study enrolled 269 asymptomatic adults with multiple CV risk factors who underwent Coronary Computed Tomography Angiography (CCTA) after prior carotid duplex ultrasound (CDUS). Coronary artery disease (CAD) was graded as absent, non-obstructive (<50% stenosis) or obstructive (≥50%), and HRPs were identified by ≥1 adverse morphological feature (low attenuation, positive remodeling, napkin-ring sign, spotty calcification). Carotid disease was classified as CDUS 0 (no plaque), CDUS 1–49% (mild), or CDUS ≥ 50% (significant). Pre-specified analyses explored prevalence of HRPs across CDUS–calcium-score strata (cut-off 100 Agatston) and independent predictors within the CDUS 1–49% subgroup. CAD was absent in 31%, non-obstructive in 41%, and obstructive in 28%. HRPs were present in 30.9% of all cases, in 26.6% of non-obstructive and in 64.6% of obstructive CAD. HRPs prevalence rose step-wise from 10.0% (CDUS 0 + Ca < 100) to 27.7% (CDUS 1–49% + Ca < 100), 41.2% (CDUS 0 + Ca ≥ 100) and 59.4% (CDUS 1–49% + Ca ≥ 100). In patients with CDUS 1–49%, current smoking independently predicted HRPs (OR 2.1, 95% CI 1.0–4.5; p = 0.049). Nearly one-third of asymptomatic adults with high CV risk already showed HRPs. Mild carotid atherosclerosis synergized with a calcium score ≥ 100 to identify a subgroup in which six of ten individuals exhibited HRPs. Smoking was the only independent clinical correlate identified of plaque vulnerability. Combined carotid ultrasound, calcium scoring and CCTA may substantially refine primary prevention risk stratification beyond traditional factors.

Coronary computed tomography angiography (CCTA) has profoundly changed the diagnostic approach to patients with suspected coronary artery disease (CAD). Originally developed as a non-invasive technique for identifying or ruling out obstructive coronary stenoses, CCTA has progressively evolved into an imaging modality capable of providing a comprehensive assessment of coronary atherosclerosis. A growing body of evidence has demonstrated that the clinical value of CCTA extends far beyond the anatomical evaluation of coronary stenosis. Modern CCTA allows for the quantification of the burden of atherosclerotic plaques, the characterization of plaque composition, the identification of high-risk plaque features, and a more accurate stratification of cardiovascular risk, moving from the concept of ischemia to that of atheroma. In addition to its role in diagnosing CAD and evaluating coronary stents and bypass grafts, CCTA is also becoming increasingly important in procedure planning, cardiovascular prevention, and the personalization of treatment strategies. Overall, this could finally represent a unique opportunity to reduce the cardiovascular burden that still weighs on health care systems. Looking ahead, the growing use of CCTA in clinical practice is creating new diagnostic, interpretive, and organizational challenges. This perspective aims to discuss the evolving role of CCTA and the necessary changes regarding the new competencies required of clinical cardiologists, interventional cardiologists, and cardiovascular radiologists, taking into account the need to redefine technological standards, multidisciplinary training programs, as well as the organization and sustainability of healthcare—including environmental impact and reimbursement models—in order to fully and fairly harness the potential of modern CCTA.