FFR-CT: Technical Advances and Implementation in Clinical Practice Kamil Stankowski, Amedeo Pellizzon, Luca Signorelli, Andrea Baggiano, Nicola Cosentino, et al. Journal of Imaging, 2026 Fractional flow reserve derived from coronary computed tomography angiography (FFR-CT) has emerged as a non-invasive modality for the functional assessment of coronary artery disease. By using computational fluid dynamics, particularly in its most extensively validated off-site implementation, FFR-CT enables lesion-specific estimation of pressure gradients across coronary stenoses without the need for invasive catheterization. This narrative review summarizes the technical foundations of FFR-CT as well as the evidence demonstrating that FFR-CT enhances the diagnostic accuracy of coronary CT angiography alone by improving specificity for hemodynamically significant stenoses when compared with invasive fractional flow reserve. Beyond diagnosis, FFR-CT provides incremental prognostic information, supporting risk stratification and guiding revascularization decisions. Suggestions for clinical implementation of FFR-CT and guidance on interpreting results within the appropriate clinical context are provided. Despite these advantages, limitations remain, including dependence on image quality, reduced performance in heavily calcified vessels, assumptions regarding hyperemic flow conditions, and limited validation in certain populations. While computational fluid dynamics-based FFR-CT remains the most commonly adopted approach in clinical settings, machine learning-based on-site FFR-CT is rapidly evolving and is expected to become a reliable alternative. As technical refinements continue, FFR-CT is poised to play an expanding role in precision-guided management of coronary artery disease.
Clinical and echocardiographic changes after intermittent levosimendan infusion in patients with advanced heart failure Mauro Riccardi, Emilia D’Elia, Fabio Fazzari, Camilla Cirelli, Stefano Bisegna, et al. Esc Heart Failure, 2026 Introduction To evaluate the short-term clinical, structural, and functional cardiac changes following intermittent levosimendan infusion and their prognostic implications in patients with advanced heart failure (AdHF). Methods In this prospective, multicentre, observational study, patients with AdHF treated with intermittent levosimendan infusion (12.5 mg at a rate of 0.1 μg/kg/min, without a bolus) were enrolled. Clinical, laboratory, and comprehensive echocardiographic assessments were performed at baseline, 48 h, and 30 days post-infusion. The primary endpoint was to evaluate the extent of clinical and cardiac structure and function changes during the first 30 days after levosimendan infusion. Secondary outcome of interest was the association of cardiac changes and a composite endpoint of decompensated HF, urgent HF rehospitalization, cardiogenic shock, cardiac arrest, and cardiovascular death at 6 months. Results A total of 37 patients with AdHF were included (mean age 71.1 ± 9.0 years; 59.5% male). A non-significant trend reduction in mean arterial pressure values was observed over time (81.3 ± 9.5 mmHg vs 80.9 ± 7.7 mmHg after 48 h vs 79.1 ± 6.9 mmHg at 30 days, P-value for trend = .079). NT-proBNP levels significantly decreased at 48 h and rose again by 30 days [from 1802 (1127–4436) ng/l to 1060 (830–3864) ng/l at 48 h and 1661 (1015–4245) ng/l at 30 days, P-value for trend = .006]. The main left ventricular (LV) and right ventricular (RV) structure and function parameters improved at 48 h but returned to baseline or a slight improvement by 30 days (LV ejection fraction: 30.9 ± 11.3% vs 32.2 ± 11.2%, vs 30.9 ± 11.3%, P-value for trend = .001; LV global longitudinal strain: −8.0 ± 3.5% vs −9.2 ± 3.5% vs −8.0 ± 3.3%, P-value for trend < .001; tricuspid annular plane systolic excursion: 16.9 ± 3.1 mm vs 17.7 ± 3.4 vs 17.0 ± 3.5, P-value for trend .007; systolic pulmonary artery pressure: 48.7 ± 15.8 mmHg vs 41.6 ± 12.7 mmHg vs 46.1 ± 15.0, P-value for trend <.001). Overall, 17 (45.9%) patients experienced CV events. After accounting for confounders, ΔLV global longitudinal strain (GLS) after 48 h (adjusted odds ratio (OR) 0.26, 95% confidence interval (CI) 0.10–0.67, P = .006) and ΔRV free wall longitudinal strain (FWLS) (adjusted OR 0.75, 95% CI 0.57–0.99, P = .041) were significantly associated with a lower risk of events. Conclusions In patients with AdHF, intermittent levosimendan infusion resulted in early improvements in NT-proBNP levels and biventricular function, which tended to wane by 30 days. Early enhancements in LVGLS and RVFWLS were independently associated with better clinical outcomes, suggesting their potential role as markers to guide patient selection and therapeutic response.
Exploring Morphologic and Functional Variants in Hypertrophic Cardiomyopathy: An Echocardiographic and Doppler Review Kamil Stankowski, Fabrizio Celeste, Manuela Muratori, Francesco Cannata, Nicola Cosentino, et al. Diagnostics, 2025 Hypertrophic cardiomyopathy (HCM) is a complex and heterogeneous myocardial disorder, best evaluated with echocardiography for initial diagnosis, risk stratification, and longitudinal monitoring. This focused review explores the echocardiographic assessment of various morphologic phenotypes of HCM, emphasizing their diagnostic nuances. Distinct phenotypes, including asymmetric septal hypertrophy, concentric hypertrophy, and the less common apical HCM, present unique imaging challenges. Additionally, the review outlines essential techniques and practical tips for assessing left ventricular apical aneurysm flow patterns and dynamic intraventricular gradients. A thorough understanding of mitral valve anatomy and its role in left ventricular outflow tract obstruction is also crucial. Finally, anatomical variants of the mitral valve, papillary muscles and left ventricular myocardium are examined for their contribution to systolic anterior motion and mid-ventricular obstruction as well as for constituting additional phenotypical expressions of HCM, beyond left ventricular hypertrophy.
