Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.

Heart failure (HF) remains a critical global health challenge, necessitating advancements in diagnostic and therapeutic strategies. This review explores the evolution of imaging technologies and their impact on HF management, focusing on three-dimensional echocardiography (3DE), myocardial strain imaging, and vortex dynamics imaging. Three-dimensional echocardiography enhances traditional echocardiography by providing more accurate assessments of cardiac structures, while myocardial strain imaging offers the early detection of subclinical myocardial dysfunction, crucial in conditions such as chemotherapy-induced cardiotoxicity and ischemic heart disease. Vortex dynamics imaging, a novel technique, provides insights into intracardiac flow patterns, aiding in the evaluation of left ventricular function, valve diseases, and congenital heart anomalies. The integration of these advanced imaging modalities into clinical practice facilitates personalized treatment strategies, enabling the earlier diagnosis and more precise monitoring of disease progression. The ongoing refinement of these imaging techniques holds promise for improving patient outcomes and advancing the field of precision medicine in HF care.

Mitral annulus calcification (MAC) is no longer seen as merely age-related. Recent evidence links MAC to calcific aortic stenosis (AS), but its prognostic value in AS patients undergoing aortic valve replacement (AVR) remains unclear. This study aims to assess the impact of cardiac CT-derived MAC on cardiovascular outcomes in this population. Pre-procedural contrast-enhanced CCT was performed, and Guerrero CCT-derived MAC score was used to quantify the MAC severity. Major adverse cardiovascular events (MACE − cardiovascular mortality, significant arrhythmias [sustained ventricular tachycardia, asystole, complete atrioventricular block], stroke, hospitalizations due to heart failure) and all-cause and non-cardiovascular mortality were assessed during the 60 months of follow-up after AVR. Multivariate Cox models evaluated the predictive value of severe MAC alongside other significant variables. A total of 313 patients with severe AS and subsequent AVR were included in the study. Among these, 34.6 % of patients had no criteria for MAC, while 65.4 % exhibited MAC (54.1 % presented mild MAC, 33.6 % moderate MAC, and 12.1 % severe MAC). In multivariable Cox models, severe MAC, moderate-to-severe mitral regurgitation, and Society of Thoracic Surgeons (STS) score > 2.5 % remained independent predictors of MACE (all p < 0.05). Also, severe MAC and STS scores > 2.5 % remained independent predictors of all-cause mortality (all p < 0.05) in multivariable analysis. The present study demonstrated that severe MAC independently predicted worse outcomes in patients undergoing AVR, suggesting that incorporating it into the clinical evaluation could ensure a critical change in patient care.

Background/Objectives: Echocardiography is the reference standard for grading aortic stenosis (AS); however, it yields discordant severity estimates in up to 40% of patients. Multidetector computed tomography (MDCT)-derived methods for calculating aortic valve area (AVA) may improve diagnostic concordance, but their diagnostic performance, validation against invasive hemodynamics, and the influence of left ventricular outflow tract (LVOT) morphology on severity grading remain insufficiently investigated. Methods: We retrospectively analyzed 307 patients with normal-flow, high-gradient calcific AS who underwent echocardiography, MDCT, and cardiac catheterization. AVA was calculated using (1) echocardiographic LVOT diameter, (2) hybrid Doppler–MDCT planimetric LVOT area, and (3) corrected echocardiographic LVOT diameter (×1.13). Agreement, correlation, and diagnostic performance were assessed using Bland–Altman analysis, Pearson correlation, ROC analysis, and McNemar’s test. Subgroups defined by diagnostic concordance and MDCT-derived LVOT size were compared using ANOVA. Results: Hybrid AVA showed a strong correlation with echocardiographic AVA (r = 0.749, p < 0.001), with a mean difference of +0.11 ± 0.15 cm². Both methods demonstrated similar relationships with invasive and non-invasive hemodynamic markers of AS severity. When combined with echocardiography, the hybrid method increased concordant classification of severe AS by 8%. In contrast, corrected AVA performed significantly worse, leading to more discordant classifications. LVOT size was significantly associated with variability in AVA and Doppler velocity index, independent of flow status. Conclusions: Hybrid MDCT-derived AVA provides diagnostic performance equivalent to echocardiography and improves concordance in selected patients. LVOT size influences key echocardiographic parameters and may warrant tailored diagnostic thresholds.

Background: Obesity and unhealthy dietary habits are among the leading modifiable determinants of cardiovascular disease, acting through biological mechanisms that extend far beyond excess body weight. Adipose tissue dysfunction, chronic low-grade inflammation, oxidative stress, endothelial impairment, mitochondrial dysfunction, and gut microbiota dysbiosis contribute to the development and progression of cardiometabolic disease. Consequently, nutrition should be regarded as a key biological modulator of cardiovascular risk, capable of influencing multiple interconnected metabolic and molecular pathways. Methods: This narrative review provides a critical and translational overview of the current evidence linking diet, obesity, and cardiovascular disease. We critically evaluated epidemiological studies, landmark randomized controlled trials, prospective cohort studies, meta-analyses, international guidelines, and relevant mechanistic investigations to examine the impact of major dietary patterns, obesity-related immunometabolic alterations, and emerging precision nutrition strategies on cardiovascular prevention and management. Results: Among currently available dietary models, the Mediterranean diet has one of the most extensive randomized evidence bases for cardiovascular prevention, including trials demonstrating reductions in major adverse cardiovascular events and other clinically relevant cardiovascular outcomes. Other healthy dietary patterns, including the Dietary Approaches to Stop Hypertension (DASH), healthy plant-based, and Nordic diets, consistently improve intermediate cardiometabolic outcomes, although evidence for hard cardiovascular endpoints is less robust. Conversely, Western dietary patterns characterized by high consumption of ultra-processed foods are associated with visceral adiposity, insulin resistance, vascular inflammation, mitochondrial dysfunction, endothelial injury, and increased cardiovascular risk. Conclusions: Contemporary evidence supports nutrition as a cornerstone of cardiovascular prevention and obesity management, with benefits may extend beyond weight reduction through modulation of key biological pathways involved in cardiometabolic disease.

Around 25%–40% of ischemic strokes are cryptogenic, with no identifiable cause despite thorough evaluation. The mechanisms behind cryptogenic strokes are often embolic, frequently originating from occult cardiac sources. An unroofed coronary sinus (UCS), a rare congenital anomaly, involves a partial or complete absence of the coronary sinus roof, leading to a connection between the left atrium and the coronary sinus. This defect can be asymptomatic or present with symptoms such as paradoxical embolism due to shunting. We present the case of a 70-year-old male with prolonged chest pain and a history of neurological symptoms, who was later diagnosed with a UCS (types III and IV) through cardiac computed tomography (CCT). A cardiac bubble test confirmed a right-to-left shunt, which was not detected on transthoracic echocardiography. This case underscores the importance of considering advanced imaging techniques such as CCT in the diagnosis of cryptogenic stroke, as echocardiography may miss defects due to poor visualization of posterior cardiac structures.