Severe aortic stenosis represents a significant prognostic burden, particularly in symptomatic patients. The advent of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients previously considered ineligible for surgical aortic valve replacement (SAVR). TAVR provides a relatively safe intervention that leads to improvements in survival, symptoms, and functional status within months of implantation. A major complication following TAVR is the occurrence of paravalvular leaks (PVLs), which have been associated with increased mortality and higher rates of heart failure-related hospitalizations. PVLs refer to abnormal blood flow between the implanted valve and the aortic wall, which can compromise the functionality of the device. Careful pre-procedural planning enables the identification of patients at higher risk for PVL development. Although the incidence of PVLs has decreased with the introduction of newer-generation transcatheter valves, the condition remains clinically relevant. Due to the complex anatomy of the aortic valve apparatus and interference from the prosthetic frame, accurate evaluation of PVLs requires a multimodal diagnostic approach. Current evidence on PVL management is limited. In most cases, a conservative approach is adopted, while interventional strategies (such as pre- and post-dilatation, percutaneous PVL closure, and TAVR-in-TAVR) are reserved for selected patients. We performed a systematic literature review to summarize the incidence, predictors, diagnostic techniques, and management strategies of PVLs following TAVR.

Non-obstructive coronary artery disease (NOCAD) encompasses a heterogeneous group of conditions in which patients present with angina, ischemia or myocardial infarction despite the absence of obstructive epicardial stenoses. This spectrum includes myocardial infarction with non-obstructive coronary arteries (MINOCA) and angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA), entities increasingly recognized as clinically significant and associated with adverse outcomes. Advances in cardiac computed tomography (CT) have expanded the diagnostic capabilities beyond the exclusion of obstructive coronary artery disease, enabling comprehensive anatomical, functional and tissue-level assessment relevant to NOCAD. CT allows precise identification of non-obstructive atherosclerosis, high-risk plaque features, myocardial bridging and structural vascular remodelling. Quantitative and qualitative characterization of plaque burden correlates with ischemic risk and provides prognostic information that complements traditional stenosis-based evaluation. Emerging CT-derived biomarkers, such as pericoronary fat attenuation index and epicardial adipose tissue metrics, offer insight into vascular inflammation and microvascular dysfunction, key mechanisms in NOCAD. Functional CT techniques, such as CT-derived fractional flow reserve and CT perfusion imaging, enable non-invasive assessment of hemodynamic significance and microvascular impairment, although their routine use is limited by methodological variability and evolving clinical evidence. Beyond coronary evaluation, CT also provides myocardial tissue characterization, detects extracardiac causes of symptoms and contributes to comprehensive differential diagnosis. Despite its strengths, cardiac CT remains limited by spatial resolution, radiation exposure and its inability to directly visualize the microcirculation. Nevertheless, ongoing technological refinement and integration of computational modelling are likely to enhance its diagnostic and prognostic role.

Aims: Transoesophageal echocardiography (TOE) provides real-time soft-tissue anatomical information during pulsed field ablation (PFA) of atrial fibrillation. This focused technical report describes a standardized workflow in which TOE complements, rather than replaces, fluoroscopic, and angiographic guidance throughout the procedure. Technique: The workflow is organized into four consecutive phases: pre-procedural assessment, transseptal puncture, ablation–catheter configuration and positioning at the pulmonary vein ostia, and post-procedural assessment. Pre-procedural TOE focuses on exclusion of left atrial appendage thrombus, definition of pulmonary vein anatomy, assessment of the interatrial septum, and baseline evaluation for pericardial effusion. During transseptal access, orthogonal bicaval and short-axis views support puncture-site selection and continuous visualization of septal tenting, while fluoroscopy remains integral to guidewire and transseptal-system manipulation. During ablation, TOE complements fluoroscopic/angiographic guidance by depicting catheter configuration and its relationship with the pulmonary vein ostia and adjacent soft-tissue structures. At procedure completion, TOE is used to assess the iatrogenic interatrial septal defect and to exclude new pericardial effusion. Conclusion: TOE should be considered a complementary imaging modality during fluoroscopy- and angiography-guided PFA rather than a replacement for these techniques. Its principal contribution is real-time visualization of soft-tissue anatomy, transseptal puncture, catheter–tissue relationships, and immediate post-procedural complications. Prospective studies are required to quantify its incremental clinical value.

Atrial fibrillation (AF) and heart failure (HF) frequently coexist and mutually worsen prognosis, creating a complex clinical scenario in which treatment decisions are increasingly imaging driven. Catheter ablation has emerged as a pivotal rhythm control strategy in selected patients with HF, but careful phenotyping of the atrial and ventricular substrate is essential to balance potential benefits against procedural risk and the likelihood of durable sinus rhythm. In this narrative review, we summarize the role of multimodality imaging across the entire AF care pathway in patients with HF, from candidate selection to intraprocedural guidance and post-ablation follow-up. Ultrasound imaging remains the cornerstone of pre-procedural assessment. Cardiac computed tomography (CCT) refines anatomical characterization of the left atrium, pulmonary veins, and left atrial appendage. Cardiovascular magnetic resonance (CMR) offers comprehensive tissue characterization of atrial and ventricular fibrosis, allowing distinction between atrial primary and atrial secondary AF phenotypes and informing expectations of reverse remodelling. During ablation, intracardiac echocardiography and transesophageal echocardiography optimize transseptal access, catheter navigation, and complication monitoring, and they are particularly relevant with contemporary Pulsed Field Ablation systems. In follow-up, echocardiography, CCT, and CMR are pivotal for quantifying structural reverse remodelling and detecting rare but life-threatening complications such as atrio esophageal fistula and pulmonary vein stenosis. An integrated, multimodality, substrate-based imaging strategy is therefore crucial to personalize rhythm versus rate control decisions and to guide safe, effective ablation in patients with AF and HF.

Background: Psychological distress, autonomic dysregulation, and unhealthy lifestyle behaviors are common after myocardial infarction (MI) and negatively affect cardiovascular outcomes. In recent years, integrative mind–body interventions, such as yoga and mindfulness-based approaches, have gained increasing attention as adjuncts to conventional cardiac rehabilitation (CR) programs. However, evidence regarding their effectiveness in post-MI populations remains fragmented. Objective: This systematic review aimed to synthesize the available evidence on the effects of yoga- and mindfulness-based interventions in patients following myocardial infarction. Methods: A systematic literature search was conducted across major electronic databases to identify randomized controlled trials and observational studies evaluating yoga- or mindfulness-based interventions in post-MI patients. Eligible studies included adult MI populations. Study selection and quality assessment were performed according to predefined criteria. Results: The 10 included studies suggest that yoga-based cardiac rehabilitation programs may provide benefits beyond standard care, particularly in terms of self-rated health, psychological well-being, and return to pre-infarction daily activities. Mindfulness-based interventions were associated with reductions in anxiety and perceived stress, improvements in blood pressure control, enhanced social support, and better health-related quality of life. Several studies also reported favorable effects on autonomic balance and stress-related physiological markers. Finally, a study reported benefits in terms of MACE (p = 0.032). However, heterogeneity in intervention protocols, outcome measures, and study designs limited direct comparisons across studies. Conclusions: Yoga and mindfulness-based interventions appear to be promising complementary strategies in post-MI care.

Normal-flow, low-gradient aortic stenosis is one of the most deceptive presentations of aortic stenosis. It leaves clinicians uncertain whether they are facing true severe disease or a measurement artefact. This often reflects a discordant grading pattern, in which many patients ultimately prove to have moderate disease. This diagnostic paradox arises from a combination of measurement errors, geometric assumptions, and genuine hemodynamic complexity, and cannot be resolved by echocardiography alone. A structured multimodality imaging strategy integrating calcium score evaluation on cardiac computed tomography, tissue characterisation on cardiac magnetic resonance and, when necessary, invasive hemodynamic assessment is the only reliable path to diagnostic certainty and appropriate therapeutic decision-making. Together, these modalities form a coherent sequential algorithm that moves from the non-invasive to the invasive, from the hemodynamic to the biological, and from uncertainty to actionable clinical decision. This review provides an updated, critical appraisal of each imaging tool and its respective strengths and pitfalls.