Cardiac amyloidosis (CA) represents the accumulation and deposition of misfolded protein fibrils in the myocardium, resulting in progressive restrictive cardiomyopathy. Light chain (AL) and transthyretin (TTR) amyloidosis are the most common types of CA. While endomyocardial biopsy remains the gold standard for diagnosing cardiac amyloidosis, its invasive nature and associated risk of complications have led to increased reliance on clinical suspicion and noninvasive imaging modalities as alternative diagnostic tools. Over the last decade, radionuclide imaging studies have become a widely accepted tool in diagnosing ATTR CA, whereas its diagnostic utility in AL CA detection remains limited. Recent advances in PET-CT radiopharmaceuticals have further expanded the potential of nuclear imaging as a comprehensive tool for diagnosis, prognostication, and therapy monitoring. This literature review appraises the current applications of nuclear imaging in the clinical management of cardiac amyloidosis.
Coronary CT angiography is a non-invasive method of analyzing the coronary lumen through which the atheromatous bur-den can be evaluated, with the analysis of the type of plaque (soft, calcified, mixed) and the impact on the arterial lumen (stenosis, occlusion). The anatomical evaluation by coronary CT is indicated in symptomatic patients with low and medium risk factors for coronary atherosclerotic disease, in those with inconclusive laboratory and EKG results, patients with un-certain stress test results, in the evaluation of coronary grafts and intrastent stenoses. Depending on the result of the angiography, the severity of the stenosis and the management of the patient are established. In the case of mild and medium stenoses, risk factors management and drug treatment are recommended. For severe stenoses, patients are referred for interventional coronary angiography or functional evaluation. Coronary CT angiography increases the certainty of coronary atherosclerotic disease diagnosis. It has a superior discriminative capacity of plaques with low attenuation, the main predictor of myocardial infarction, with almost five-fold higher risk. Coronary CT angiography increases the adaptation of medication, and the inclusion of statin therapy decreases the risk of fatal and nonfatal myocardial infarction at 5 years and increases the quality of life.
Left ventricle systolic function is an essential parameter in different clinical scenarios and the usual methods available for its assessment are sometime suboptimal, depending on the filling conditions of the heart. Therefore, the development and implementation in clinical practice of a new parameter for assessing left ventricle contractile function is desirable. Mechanical work defined as energy transferred to or from an object via the application of force along a displacement seems to be a promising method for myocardial performance estimation. Although initially this parameter was calculated on the left ventricle volume-pressure curve estimated by cardiac catheterization, an easier method considering non-invasive left ventricle pressure and global longitudinal strain assessed by speckle tracking echocardiography was developed recently. Myocardial work offers information regarding the segmental and global function of the left ventricle, and it is considered a more sensitive marker for assessing left ventricle performance compared to ejection fraction and global longitudinal strain. Its applicability in various cardiac pathologies was demonstrated recently in several studies and its use in every day practice may bring important additional information for clinical decision making.
Cardiovascular-kidney-metabolic (CKM) syndrome describes the complex, bidirectional interplay among cardiovascular, renal, and metabolic dysfunctions, where impairment in one system accelerates decline in the others. This interconnected pathophysiology significantly elevates the risk and progression of heart disease, particularly heart failure, through mechanisms involving insulin resistance, systemic inflammation, neurohormonal activation, and endothelial dysfunction. In this context, therapeutic strategies targeting heart disease must address the multifaceted drivers of CKM. Recent advances highlight the need for an integrated, patient-centered approach that combines lifestyle interventions with pharmacological treatments tailored to individual cardiovascular risk. While foundational therapies such as RAAS inhibitors and statins remain essential, novel agents now offer additional prognostic and quality-of-life benefits. SGLT2 inhibitors have emerged as a cornerstone therapy, improving outcomes in heart failure with both preserved and reduced ejection fraction, independent of glycemic control. GLP-1 receptor agonists and dual GLP-1/GIP agonists like tirzepatide demonstrate cardiometabolic and renal protection, while finerenone shows promise in diabetic kidney disease and several heart failure phenotypes. These therapies not only target glycemic control but also reduce cardiovascular mortality, hospitalizations, and renal decline. Optimizing cardiovascular outcomes in CKM syndrome requires early, multifactorial therapeutic intervention, informed by evolving evidence and a deeper understanding of the heart–kidney–metabolism axis.
As reported by literature, rheumatoid arthritis is a rheumatic disease with an increased risk of developing cardiovascular complications. Early detection of atherosclerosis by non-invasive techniques represent a current challenge of patient management. Current EULAR guidelines recommend careful monitoring of cardiovascular risk factors by stratification of patients and strict control of rheumatic disease activity to reduce it. The classic evaluation of intima- medium thickness (IMT) was completed by quantifying the degree of inflammation of the carotid plate using positron emission tomography or the degree of coronary calcifications by calculating Agatston score using Coronary Computer Tomography. These modern investigation techniques allow identification of several subclinical stages of atherosclerosis, the interest in their early detection resulting from the fact that, in this stage, through specific measures, the cardiovascular complications can be prevented.
Introduction: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints associated with HLA B27 antigen and with the predominance of the male gender (with an average between 20 and 30 years old). Case presentation A 48 years old male patient was admitted to our clinic, having a long history regarding this disease since he was 16. This patient has switched 3 therapies with anti TNF alpha agents until now, and we hope to obtain a good response for a long time. During the treatment with Etanercept he presented an acute anterior uveitis which had a good response to therapy. Conclusion: The ankylosing spondylitis management is complicated when we have the possibility to choose only three anti TNF alpha agents. If a patient does not respond to the first or second agent we are constrained to follow the last one. Therefore the principal problem regarding this special case is that the patient is non responder at the last agent. So the question that arises is witch will be the next therapy for this patient? INTRODUCTION Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints – asymmetric. Its major characteristic is the early damage of the sacroiliac joint, ascending to ankylosis. The incidence is increased for males between 20 and 30 years old, thus most of the patients are associating a HLA B27 antigen. The existence of cardiovascular risk due to inflammatory rheumatic diseases for decades but the real significance and therapy designed to control this risk has been recently evaluated. is known Systemic inflammatory rheumatic diseases accelerates atherosclerosis and inflammation because of destabilizes plaque of atheroma, contributing to an increased frequency of fatal cardiovascular events such as myocardial heart attacks and strokes. The ankylosing spondylitis cardiovascular events include: aortic damage (dilatation/hypertrophy), nerve impulse conduction disorders, accelerated atherosclerosis. heart muscle insufficiency, pericarditis, and Anti TNF-alpha therapy leads to a decrease of the disease activity score the nonspecific inflammatory syndrome. (BASDAI) and also The anti TNF approved drugs which are currently in clinical practice are: 1 Carol Davila Central University Emergency Military Hospital, Bucharest 39
Behcet's disease is a rare and poorly understood condition with multiple systemic manifestations. The disease causes inflammation in blood vessels throughout the body which leads to numerous symptoms that may appear and disappear unpredictable. Case presentation A 33 year old woman was admitted (interned) to our clinic. Her family medical history reveals – multiple strokes (father) and autoimmune thyroiditis (sister). The onset of her symptomatology was in 2013 and it consisted of fever (39-40 Celsius degrees) sicca syndrome and persistent headaches, recurrent oral and genital ulcerations. An important event is essential to be mentioned -the patients has suffered an episode of upper gastrointestinal bleeding (hemoglobin has dropped to 2.5g/dl which has led to cardiac arrestresuscitated). The lab tests showed: C3 hypocomplementemia, Anti-centromere antibodies (-), anti-b2gp1 antibody (+), lupus anticoagulant (+), U1RNP(-). We started to administrate cyclophosphamide to the patient, thus his condition has improved after the 2nd dose. At the 12-month evaluation we were able to see a significant clinical and biological improvement. Conclusions In order to be able to talk about “evidence based medicine” for the management of Bechet’s disease, a large number of clinical trials is required to provide to the attending physicians the necessary data for diagnosis and treatment.
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.
