Background Appropriateness of use criteria (AUC) for transthoracic echocardiography (TTE) have been developed by American cardiology associations to help avoid unnecessary scans by formalizing indications for imaging. There are 98 indications classified as either appropriate (A), inappropriate (I), or uncertain (U). AUC may allow better targeting of limited resources, but they have not been tested systematically outside the USA. Aim of the study To test AUC in Wales, one of the four countries of the UK. Methods We collected requests for TTE and the corresponding TTE reports from all Welsh hospitals during 1 week in June 2012 and analysed them according to appropriateness, specialty, and location (secondary vs. tertiary services) of the referring physician. Results We analysed 1070 pairs of echocardiography requests and TTE reports from 14 hospitals [mean age 66.5 (16.1) years; 579 (51%) M]: A—922 (86%); I—115 (11%), and U—33 (3%); 287 (25%) studies were from two tertiary centres and 338 (29.5%) were of inpatients. Main indications were the evaluation of: cardiac structure and function (489, 45.7%), valvular function (267, 25%), and hypertension, heart failure, or cardiomyopathy (149, 13.9%). In-patient requests (main indication—‘initial evaluation of left ventricle ejection fraction post acute coronary syndrome’—44 studies, 13.7%) were more often appropriate than outpatients (main indication—‘symptoms/conditions potentially related to suspected cardiac aetiology’—142 studies, 19.8%): 94.4 vs. 83.5%, P < 0.05. The most common inappropriate indication was ‘initial evaluation for a murmur/click without symptoms/signs of structural heart disease’ (29 studies, 2.7%). The proportion of appropriate requests by specialty was 89% for medical, 87% for GPs, 85.3% for cardiologists, 80.8% for surgical, and 60% for cardiac surgeons ( P < 0.05 for cardiac surgeons); 47.8% of requests were generated by cardiologists, and abnormalities were detected in 82% of all scans (37% minor findings and 45% major findings), least often in those requested by general practitioners. Conclusion Application of AUC yields results similar to those reported from the USA; ∼1 in 10 scans could be avoided.

The cardiovascular risk imposed by chronic kidney disease is significantly enhanced, and carotid atherosclerosis is an early indicator of systemic vascular damage. In this review, we summarize available data relative to primary prevention strategies for carotid atherosclerosis in chronic kidney disease (CKD) with a focus on risk-adapted and stage-specific management. We conducted a narrative review of the literature. A structured literature search was performed in major databases (PubMed, Scopus, Web of Science and Google Scholar), focusing on studies published between 2012 and 2025, including observational studies, randomized controlled trials, and international guideline recommendations. The review focuses on blood pressure management, lipid-lowering therapy, glycemic control, antiplatelet therapy, as well as lifestyle interventions and screening strategies in patients with CKD without a history of cerebrovascular events. CKD-specific processes, such as inflammation, endothelial dysfunction and vascular calcification, may influence the progression of carotid plaques, highlighting the need to improve traditional and non-traditional risk factor management. The focus of prevention continues to emphasize blood pressure (BP) and lipid control as well. At the same time, routine carotid screening and systematically implemented antiplatelet therapy have no known benefit, but the potential for elevated bleeding risk, especially in advanced CKD. Primary prevention should therefore focus on optimal medical treatment, as well as disease-specific strategies according to CKD stage. Additional CKD-specific studies with carotid endpoints are necessary.

Background: Degenerative aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CM), particularly wild-type ATTR (ATTRwt), are age-associated disorders that frequently converge in elderly patients. Their coexistence may obscure diagnosis, amplify heart-failure burden, and complicate risk stratification before and after aortic valve replacement. Methods: This narrative review was conducted using a structured literature search focused on ATTR-CM, AS, transcatheter aortic valve implantation/replacement (TAVI/TAVR), and nuclear cardiology. Priority was given to cohort studies, systematic reviews, consensus documents, and guideline statements. Main findings: Across observational cohorts and meta-analyses, ATTR-CM is consistently identified in a clinically meaningful minority of older patients with severe AS, especially among those referred for TAVI. Reported prevalence varies with age, referral pathway, diagnostic protocol, and whether equivocal grade 1 uptake is included, but most contemporary TAVI-oriented cohorts place definite ATTR-CM in the high single-digit to mid-teen percentage range. Clinical suspicion should increase in patients with disproportionate left-ventricular wall thickening, low-flow low-gradient AS, restrictive physiology, elevated cardiac biomarkers, conduction disease, atrial fibrillation, or extracardiac ATTR clues such as bilateral carpal tunnel syndrome. Conclusions: Bone-avid tracer scintigraphy with 99mTc-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, or 99mTc-hydroxymethylene diphosphonate, interpreted with SPECT or SPECT/CT and combined with mandatory exclusion of a monoclonal protein, enables robust non-biopsy diagnosis of ATTR-CM. In severe AS, nuclear diagnosis should be embedded in a pragmatic, multidisciplinary pathway that identifies patients likely to benefit from valve intervention, ATTR-specific therapy, genetic testing, and tailored follow-up.