Transthyretin amyloid cardiomyopathy (ATTR-CM) is a complex and serious form of heart failure caused by the accumulation of transthyretin amyloid protein in the heart muscle. Variable symptoms of ATTR-CM can lead to a delayed diagnosis. Recognizing the diagnostic indicators is crucial to promptly detect this condition. A targeted literature review was conducted to examine the latest international consensus recommendations on a comprehensive diagnosis of ATTR-CM. Additionally, a panel consisting of nuclear medicine expert consultants (n = 10) and nuclear imaging technicians (n = 2) convened virtually from the Kingdom of Saudi Arabia (KSA) to formulate best practices for ATTR-CM diagnosis. The panel reached a consensus on a standard diagnostic pathway for ATTR-CM, which commences by evaluating the presence of clinical red flags and initiating a cardiac workup to assess the patient’s echocardiogram. Cardiac magnetic resonance imaging may be needed, in uncertain cases. When there is a high suspicion of ATTR-CM, patients undergo nuclear scintigraphy and hematologic tests to rule out primary or light-chain amyloidosis. The expert panel emphasized that implementing best practices will support healthcare professionals in KSA to improve their ability to detect and diagnose ATTR-CM more accurately and promptly. Diagnosing ATTR-CM accurately and early can reduce morbidity and mortality rates through appropriate treatment.

Introduction: Telemedicine is a desirable option for healthcare in Saudi Arabia. The challenges of telemedicine in cardiovascular care in Saudi Arabia are not known. The COVID-19 pandemic offered an unprecedented opportunity to identify real-life challenges of telemedicine in Saudi Arabia. We sought to identify the challenges of telemedicine among patients with cardiovascular diseases using the experience of the COVID-19 pandemic. Methods: This is a cross-sectional survey-based study through a self-filled questionnaire. The questionnaire included demographic data, type of cardiovascular disease, and difficulties faced by the patients during the COVID-19 lockdown. Results: 394 (60% male, mean age 51.4 ± 19.3 years) participated in the study. 30.3% had valve diseases, 26.4% had heart failure, and 24.1% had coronary artery disease. 45.6% reported difficulty with telemedicine during COVID-19 lockdown. Among those who have difficulties, almost half of the participants had difficulty with the cancellation of telemedicine appointments, and 15.5% had difficulty in getting medications. Conclusion: Cancellation of telemedicine appointments and getting the medications were cardiovascular patients’ main challenges during the COVID-19 lockdown. Telemedicine is a feasible option for the follow-up of chronic cardiovascular diseases. Therefore, it should be implemented to increase the availability of specialized cardiovascular care over a wide geographical area.

Background: Coronary artery disease (CAD) poses a significant global health burden, necessitating optimal diagnostic strategies for risk assessment and management. This study systematically reviews randomized controlled trials (RCTs) comparing different noninvasive imaging modalities for CAD evaluation, focusing on their subsequent invasive outcomes and major adverse cardiac events (MACEs). Methods: A comprehensive electronic search was conducted across multiple databases, identifying 24 relevant RCTs published between 2010 and 2023. Key outcomes assessed included downstream referral to invasive testing, MACE rates, cost-effectiveness, and hospitalization outcomes. Results: The majority of included RCTs focused on comparing coronary computed tomography angiography (CCTA) with alternative imaging techniques. While CCTA is often associated with increased invasiveness, it demonstrates slightly better MACE rates, cost-effectiveness, and hospitalization outcomes compared to other imaging modalities. Conclusion: Continued investigation into alternative noninvasive diagnostic methods for CAD is essential to advance clinical practice and optimize patient care. By exploring new strategies beyond CCTA and leveraging technological innovations, health-care providers can improve diagnostic precision, mitigate procedural risks, and ultimately enhance outcomes for individuals with CAD.

Background/Objectives: The use of direct oral anticoagulants (DOACs) in obese patients is scarcely studied despite having many advantages over warfarin. Consequently, this study aims to assess the real-world safety and effectiveness of apixaban compared to warfarin in treating atrial fibrillation (AF) in obese patients. Methods: A retrospective cohort study examined consecutive AF patients with a BMI of ≥ 30 kg/m² treated with apixaban or warfarin. Patients were started on these medications between January 2015 and December 2021. Efficacy outcomes included ischemic stroke and venous thromboembolism (VTE) occurrences, while safety outcomes encompassed bleeding incidents and mortality rates. Outcomes were assessed following propensity score matching. Results: We identified 876 patients treated with either apixaban (414) or warfarin (462). Their mean age was 76.9, with a mean CHA₂DS₂VASc score of 4.9 ± 1.97. After matching and compared to warfarin, apixaban was correlated with a lower incidence of all-cause mortality (19.7% vs. 33.7%, p < 0.001). The incidences of stroke, venous thromboembolism (VTE), and bleeding events were (4.7% vs. 4.7%, p = 1.000), (1.0% vs. 2.6%, p = 0.107), and (3.9% vs. 6.2%, p = 0.139), respectively. Using Cox-regression model, apixaban was associated with lower mortality risk (HR = 0.728, 95% CI: 0.55–0.97; p = 0.030) which remained significant after adjusting for the conventional cardiovascular risk factors and BMI values. Conclusions: Apixaban is associated with a trend of reduced incidence of thromboembolism among obese patients with atrial fibrillation and significantly lowers all-cause mortality. Despite earlier concerns, the use of apixaban is an effective and safe alternative to warfarin among obese patients with AF.