Background and Objectives: Coronary computed tomography angiography (CCTA) has become a central non-invasive imaging modality for the evaluation of suspected chronic coronary syndromes. Nevertheless, referral patterns and sex-related differences in real-world CCTA utilization may vary according to demographic structure, healthcare accessibility, and regional clinical practice. The present study aimed to evaluate age- and sex-related patterns in CCTA referrals and coronary atherosclerotic burden within a real-world Eastern European single-center CCTA referral cohort. Materials and Methods: We performed a retrospective analysis of 2742 consecutive CCTA examinations at a tertiary center in Sibiu, Romania, between March 2019 and January 2025. The demographic profile of the referral cohort was compared with the adult population structure of Sibiu County. Subsequently, an age- and sex-stratified proportional subsample of 397 cases was selected from the CCTA cohort for detailed analysis of sex-related differences regarding coronary artery calcium score (CACS), significant coronary stenoses, and significant cardiovascular event risk. Results: The age distribution of the CCTA referral cohort differed significantly from that of the adult county population (p < 0.01), with referrals concentrated predominantly between 55 and 79 years of age. Female patients were overall more frequently represented within the referral cohort compared with the underlying county population; however, males demonstrated significantly higher coronary artery calcium scores, a greater prevalence of significant coronary stenoses, and higher revascularization risk compared with females—particularly between 50 and 79 years of age—within the stratified proportional subsample. In contrast, patients younger than 40 years demonstrated very low rates of significant coronary disease regardless of sex. Conclusions: This study provides a real-world perspective on age- and sex-related patterns in CCTA utilization and coronary atherosclerotic burden within an Eastern European imaging center. The findings highlight the interaction between demographic structure, guideline-directed diagnostic strategies, and coronary imaging utilization in routine clinical practice.

Ischemic heart disease is the most common heart pathology in medical practice. Proper assessment of the size of myocardium injury and its consequences on the heart function is extremely important both for a correct drug therapy and for interventional approach. Most frequently the left ventricle is affected. The need for accurate evaluation of the impact of left ventricular myocardial damage has led to the development of new imaging techniques and improvement of the existing ones. At the moment the most commonly used imaging method for the assessment of left ventricular function is echocardiography. Cardiac Magnetic Resonance and nuclear tomography are precious imaging techniques as well. They are more expensive but bring valuable information when used in adequate situations.

Background: Ischemic heart disease (IHD) diagnosis is complicated by anatomical-functional dissociation, where morphological stenosis severity fails to reliably predict hemodynamic significance. This diagnostic gap necessitates a shift toward integrated physiological and structural phenotyping, a role increasingly fulfilled by Cardiovascular Magnetic Resonance (CMR). Objective: To systematically evaluate the incremental diagnostic and prognostic value of CMR across the clinical spectrum of IHD, defining its evidence-based integration into multimodal pathways, particularly for diagnostically indeterminate cases. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. A structured literature search of PubMed, Web of Science, and Scopus retrieved peer-reviewed articles published between January 2021 and April 2026. Methodological quality was appraised using the Newcastle–Ottawa Scale and AMSTAR 2, while evidence certainty was evaluated via the GRADE framework. Results: Thirty studies were included in the qualitative synthesis. Current evidence demonstrates that stress perfusion CMR provides superior diagnostic accuracy compared with traditional tests (e.g., SPECT, stress ECG), although it may be outperformed by advanced CT-derived fractional flow reserve in specific post-CCTA cohorts. In indeterminate presentations such as MINOCA, CMR accurately reclassified the underlying etiology in approximately 68% of cases. Furthermore, multiparametric assessment—integrating late gadolinium enhancement (LGE), microvascular obstruction (MVO), and global longitudinal strain (GLS)—refined post-infarction short- and medium-term risk stratification beyond LVEF alone, though the independent prognostic value of MVO attenuates in long-term follow-up (>6 years). Emerging data support the non-inferiority of accelerated stress-only protocols and the utility of artificial intelligence-driven analytics. Conclusions: CMR is a critical modality for resolving anatomical-functional mismatches and providing robust risk stratification. However, evidence does not support its use as a universal first-line test due to operational costs, scan duration, and patient contraindications. Expanding its clinical impact relies strictly on standardizing protocols and adopting AI-assisted, accelerated sequences to mitigate logistical barriers.