Diabetes mellitus (DM) is a multifaceted disorder with a pandemic spread and a remarkable burden of cardiovascular mortality and morbidity. Diabetic cardiomyopathy (DBCM) has been increasingly recognized as the development of cardiac dysfunction, which is accompanied by heart failure (HF) symptoms in the absence of obvious reasons like ischemic heart disease, hypertension, or valvulopathies. Several pathophysiological mechanisms have been proposed, including metabolic disorders (e.g., glycation products), oxidative stress, low-grade inflammation, mitochondrial dysfunction, etc., which should guide the development of new therapeutic strategies. Up to now, HF treatment has not differed between patients with and without diabetes, which limits the expected benefits despite the high cardiovascular risk in the former group. However, DBCM patients may require different management, which prioritize anti-diabetic medications or testing other novel therapies. This review aims to appraise the challenges and prospectives of the individualized pharmaceutical therapy for DBCM.

Cardiac computed tomography (CT) has become an essential imaging modality in structural cardiac interventions, providing high-resolution anatomical and functional assessments. Moreover, the role of cardiac CT spans pre-procedural planning, intra-procedural guidance, and post-procedural follow-up in interventions such as transcatheter aortic valve implantation (TAVI), mitral, tricuspid, and pulmonary valve interventions, left atrial appendage occlusion (LAAO), atrial septal defect (ASD), and paravalvular leak (PVL) closures. Furthermore, compared to traditional imaging techniques, cardiac CT offers superior spatial resolution, precise anatomical characterization, and improved procedural success rates by minimizing complications. Additionally, advances in artificial intelligence (AI)-driven CT analysis, perfusion imaging, and four-dimensional cardiac CT are expanding the associated applications. This review discusses the current role, benefits, limitations, and future perspectives of cardiac CT in guiding structural heart interventions.

Aims: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities requiring further investigation to assess aetiology. The European Society of Cardiology guidelines recommend advanced tests to establish an underlying mechanism. We evaluated advanced diagnostic testing utilization and real-world adherence to the current guideline in an international MINOCA registry. Methods and results: DOMINO is a prospective, multicentre, non-commercial registry enrolling 365 patients with MINOCA across 17 centres in 13 countries. Advanced testing was defined as cardiac magnetic resonance (CMR), intracoronary imaging, and/or invasive coronary functional assessment. The association between advanced testing and diagnostic resolution was assessed by multivariable logistic regression, with standard, cluster-robust, and generalized estimating equation (GEE) approaches to account for clustering by centre. Guideline-directed testing was performed in 254/365 (69.6%) and varied markedly by country (0–100%, P < 0.0001). A specific etiologic diagnosis was reached in 337/365 patients (92.3%). Advanced testing was associated with diagnostic resolution in the standard and GEE models, with a directionally consistent but non-significant cluster-robust estimate [standard odds ratio (OR) 3.94, 95% confidence interval (CI) 1.59–10.06; cluster-robust OR 3.75, 95% CI 0.95–14.72, P = 0.058; GEE OR 3.69, 95% CI 1.04–13.11]. Diagnostic resolution increased progressively with the extent of testing performed, from 85.6% with no advanced testing to 97.1% with CMR plus invasive/functional assessment (trend P = 0.02). Discharge pharmacotherapy varied significantly by etiologic diagnosis (P = 0.0001). Conclusion: Advanced diagnostic testing was associated with a higher likelihood of a determined etiologic diagnosis in MINOCA, despite marked international variability in its use; however, this association is partly definitional, as advanced testing directly contributes to diagnostic ascertainment for several etiologic categories. These findings nonetheless support closing the guideline-practice gap in advanced testing, while underscoring the need to distinguish mechanistically confirmed diagnoses from presumptive ones.

Transcatheter Closure of a Patent Foramen Ovale With a Small Adjacent Atrial Septal Defect and a Double Interatrial Septum Post Cryptogenic Stroke

Background and Objectives: Electrocardiography (ECG), though non-specific, is widely applied as a valuable tool in the diagnostic work-up of acute myocarditis. Cardiac magnetic resonance (CMR) has become a key non-invasive tool. This study assessed the association of ECG findings (at baseline), echocardiographic parameters, circulating biomarkers, and CMR imaging features (myocardial edema and late gadolinium enhancement—LGE) in patients with acute myocarditis. Materials and Methods: This single-center, retrospective observational study included 86 patients admitted with acute myocarditis from January 2021 to December 2024. Data collected included demographics, clinical presentation, ECG, echocardiography, biomarkers (CRP, troponin I), and CMR imaging performed during hospitalization and at the six-month follow-up. Based on ECG findings, patients were stratified into three groups: no ST elevation or T-wave abnormalities (NSTG, n = 27), T-wave abnormalities (TWAG, n = 24), and ST elevation (STEG, n = 35). Results: We enrolled 86 patients (median age: 26 years; 87.2% male), and the most frequent CMR findings were either LGE (80.2%) and/or myocardial edema (75.6%). The prevalence of edema and LGE was higher in the STEG (both 91.2%) compared to TWAG (65.2%, 77.3%, respectively) and NSTG (57.7, 65.4%, respectively) (p < 0.05). Peak troponin levels were also higher in the STEG than other groups (p = 0.005). In logistic regression analysis, TWAs were independently associated with both edema (OR = 3.15, 95% CI: 1.078–9.189, p = 0.036) and LGE (OR = 3.93, 95% CI: 1.256–12.276, p = 0.019). Biomarkers were associated with lower LVEF in univariate analysis, but not in multivariate models. Conclusions: ECG abnormalities, particularly STE and TWA, are common in acute myocarditis and significantly associated with CMR findings. Although CMR remains essential for definitive diagnosis and risk stratification in acute myocarditis, ECG may serve as a valuable initial screening tool in the context of a multimodal diagnostic approach.