The impact of contractile reserve on clinical outcomes in patients with left ventricular dysfunction undergoing TAVI.

Incidence of Elevated Cardiac Biomarkers in Patients Presenting to the Emergency Department With Allergic Symptoms: Implications for the Diagnosis of Kounis Syndrome.

Stress Cardiac Magnetic Resonance Ischemia Burden and Cardiovascular Events: Post-Hoc Analysis From the ISCHEMIA Trial.

Hypertrophic cardiomyopathy (HCM) requires multimodality imaging for accurate diagnosis, risk assessment, and management strategies. Echocardiography serves as the primary imaging tool, evaluating left ventricular wall thickness, outflow tract gradients, and mitral valve morphology. It provides essential diagnostic information and guides treatment decisions, with stress echocardiography particularly valuable for detecting dynamic gradients in obstructive HCM and supporting preoperative planning for interventions such as myectomy. Cardiovascular MRI complements echocardiography through superior resolution, enabling detailed assessment of myocardial mass, flow dynamics, and comprehensive tissue characterization. Late gadolinium enhancement and extracellular volume measurements enhance prognostic evaluation and risk stratification. Cardiac MRI excels at helping distinguish HCM from phenocopies like infiltrative or storage diseases and detecting myocardial disarray, microvascular dysfunction, and abnormalities in myocardial metabolism. Nuclear imaging proves crucial for identifying HCM phenocopies, including transthyretin amyloidosis and sarcoidosis, providing specific diagnostic capabilities. Cardiac CT, while having a secondary diagnostic role, becomes invaluable for evaluating coronary anatomy in patients considered for septal reduction therapies, ensuring comprehensive preoperative assessment. This integrated multimodal approach provides comprehensive HCM evaluation, enabling precise diagnosis, robust risk stratification, and individualized treatment planning. Each modality contributes unique strengths that collectively enhance clinical decision-making and optimize patient outcomes in this complex myocardial disease. Keywords: Cardiomyopathies, Applications-Multimodal, CT, Echocardiography, MR Imaging, SPECT, SPECT/CT, Cardiac Supplemental material is available for this article. © RSNA, 2025.

Exercise stress echocardiography (ExE) includes assessment of regional wall motion and EKG changes and, not uncommonly, discordant results are observed. Though stress induced wall motion abnormalities are widely considered positive for presence of ischemia, EKG-only positive studies are dismissed as equivocal/false positive, in which case, further evaluation is appropriate. Patients who had undergone a clinically indicated ExE and subsequent coronary CT angiogram (CCTA) within one month were identified. They were categorized based on the discordant results of the echocardiographic and electrocardiographic components of the study (EKG+/ECHO-, EKG-/ECHO+). The CCTA results were classified using CAD-RADS 2.0. CT fractional flow assessment was performed for 30-90% stenosis lesions. 197 patients with discordant ExE results were identified (EKG+/ECHO- n = 159, EKG-/ECHO + n = 38). 35.2% of the EKG+/ECHO- group were classified as CAD-RADS 3 or greater (28.9% left anterior descending, 12.6% left circumflex, and 15.1% right coronary artery moderate/severe stenoses). Of the EKG-/ECHO + patients, 23.7% were classified as CAD RADS 3 or greater (15.8% left anterior descending, 5.3% left circumflex, and 10.5% right coronary artery moderate/severe stenoses). No statistically significant difference was observed between the two groups in the overall degree of coronary artery disease. Discordant ExE results with ST segment depressions during exercise without regional wall motion abnormalities (EKG+/ECHO-) and discordant ExE results without ST segment changes with stress-induced regional wall motion abnormalities (EKG-/ECHO+) are both associated with a clinically relevant burden of coronary artery disease, without a statistically significant difference in the degree or severity between the two groups.

The diagnostic, therapeutic, and prognostic management of patients with suspected acute coronary syndrome (ACS) is a major challenge for clinicians in both emergency and outpatient settings. While clear-cut cases of acute myocardial infarction typically require immediate invasive coronary angiography (ICA), more nuanced and complex presentations require careful selection of the most appropriate diagnostic tests to determine the underlying cause of symptoms. This narrative review aims to delineate specific scenarios in which non-invasive multimodal imaging techniques-such as transthoracic echocardiography (TTE), coronary computed tomography angiography (CCTA), cardiac magnetic resonance (CMR), and nuclear imaging-are appropriate and optimal in the setting of ACS. In the initial assessment of a patient with suspected ACS, TTE is essential to identify regional wall motion abnormalities (RWMA) with a typical "coronary pattern". In recent years, the use of speckle tracking echocardiography has been shown to increase diagnostic sensitivity in this setting, particularly in patients without overt RWMA. Stress echocardiography also holds diagnostic value in specific low-risk ACS settings. Moreover, in this patient population, CCTA has demonstrated a very high negative predictive value (NPV) across multiple trials, effectively reducing the number of unnecessary ICA. Recently, this technique has been enhanced by the ability to perform qualitative analysis of atherosclerotic plaque, allowing the identification of high-risk features associated with instability and rupture, and thus with ACS. Finally, CMR enables myocardial tissue characterization, which is essential in the diagnostic work-up of myocardial infarction with non-obstructive coronary arteries (MINOCA) and also serves as an effective gatekeeper in suspected non-ST elevation myocardial infarction (NSTEMI) through the exclusion of mimickers such as myocarditis, thereby reducing the number of useless ICA. Moreover, CMR is supported by substantial evidence regarding its prognostic value in ACS patients. When available, myocardial perfusion imaging, using single photon emission tomography or positron emission tomography, has a valuable role in patients with suspected ACS and non-diagnostic ECG and biomarkers; in fact, it can detect inducible ischemia and prior infarction with a high NPV supporting safe discharge and reducing unnecessary admissions. We aim to point out the role of non-invasive multimodal imaging in patients with confirmed or suspected ACS. By analyzing the available evidence and current guidelines, it's clear that these imaging techniques are especially useful in cases of low pre-test ACS probability, low-risk NSTEMI, in ruling out alternative diagnoses, and in specific diagnostic work-up such as MINOCA. In clinical practice, our goal is to provide practical recommendations for the clinicians on when and how to apply non-invasive imaging to reduce the number of ICA in order to minimize redundant, costly, and invasive diagnostic procedures that carry an inherent risk of complications.

Stress imaging in paediatric cardiology and congenital heart disease patients has an increasing role for functional assessment. Indications include coronary artery anomalies and disease in association with anomalous aortic origin of coronary arteries, Kawasaki disease or surgical manipulation of the coronary ostia, as well as assessment of elevated filling pressures, dynamic left ventricular outflow obstruction or significance of valvular heart disease. This review provides practical guidance focused on commonly used stress echocardiography and stress cardiovascular magnetic resonance in context of their clinical indications for this age group.

Heart transplantation significantly enhances survival and quality of life for patients with end-stage heart failure. Despite advances in surgical and postoperative care, immune-mediated complications, acute graft rejection and cardiac allograft vasculopathy (CAV), remain major barriers to long-term success. Acute rejection predominantly affects early posttransplant survival, whereas CAV becomes a leading cause of mortality in later years. The gold standards for diagnosis, endomyocardial biopsy for rejection and coronary angiography for CAV, are invasive and imperfect. Noninvasive multimodality imaging is increasingly used to complement or, in selected scenarios, defer invasive testing. Echocardiography with strain detects early myocardial dysfunction when ejection fraction is preserved; stress echocardiography provides prognostic information for CAV. Quantitative techniques, positron emission tomography myocardial blood flow/myocardial flow reserve and quantitative cardiac magnetic resonance perfusion, improve detection of diffuse, stage-dependent CAV compared with qualitative assessments. Cardiac magnetic resonance tissue mapping characterizes edema and fibrosis relevant to rejection surveillance; fluorodeoxyglucose-positron emission tomography for inflammation is emerging but remains investigational in most centers. Cardiac computed tomography angiography defines coronary anatomy and plaque with excellent negative predictive value and offers physiologic assessment with computed tomography-myocardial perfusion imaging/computed tomography-derived fractional flow reserve; it is best used strategically rather than as an annually repeated test. This contemporary review synthesizes the strengths, limitations, and practical roles of echocardiography, nuclear imaging, cardiac magnetic resonance, and cardiac computed tomography angiography across adult and pediatric populations; highlights areas where quantitative methods add incremental value; and provides pragmatic, stage-aware surveillance frameworks. Integrating modalities can reduce reliance on invasive procedures, lower procedural risk, and refine therapeutic decision-making benefits that are particularly relevant for children and other patients for whom repeated invasive testing is undesirable.

Left ventricular myocardial work (LVMW) represents an innovative tool based on echocardiography designed to assess left ventricular (LV) performance in conjunction with LV pressure patterns. Although previous studies have compared differences in LVMW among patients with Fabry disease (FD), cardiac amyloidosis (CA), and hypertension at rest, there is limited research on the characteristics of LVMW in patients with FD during exercise. This study aims to explore the characteristics of LVMW at rest and during exercise in patients with FD and the value of LVMW combined with stress echocardiography for the early detection of impaired cardiac function in subclinical Fabry patients. This cross-sectional study included 54 participants, comprising 23 healthy individuals and 31 patients with FD. All participants underwent comprehensive two-dimensional echocardiography and semi-supine exercise stress echocardiography tests. At rest, individuals with FD exhibited markedly lower LV global longitudinal strain (LVGLS), LV global myocardial constructive work (LVGCW), LV global myocardial work efficiency (LVGWE), and LV global myocardial work index (LVGWI) compared to healthy controls. During exercise, LVGLS, LVGWI, LVGCW, and LV global wasted myocardial work (LVGWW) markedly increased in patients with FD and controls, while LVGWE decreased. However, across the four phases (rest, 25 W, peak, and recovery), patients with FD consistently demonstrated lower LVGLS, LVGWI, LVGWE, and LVGCW compared to controls. Moreover, the rise in LVGWI and LVGCW from the rest phase to the peak stage was markedly smaller in individuals with FD than in controls. A moderate correlation was found between LVGWI and LVGWE with LV mass index (LVMI) in individuals with FD (LVGWI: r = − 0.57, P < 0.05; LVGWE: r = − 0.68, P < 0.001). Additionally, individuals with FD with LV hypertrophy (LVH) exhibited lower LVGLS, LVGWE, and LVGCW from the rest to peak than those without LVH. Individuals with FD who had normal LVGLS at rest or those without LVH still showed markedly lower LVGWI than controls during the resting phase. Additionally, at peak exercise, LVGLS, LVGWI, and LVGCW were diminished significantly in the individuals with FD relative to the control cohort. ROC curve analysis in both resting and exercising states showed that LVGWI (rest: AUC 0.86, sensitivity 87%, specificity 74%; peak: AUC 0.94, sensitivity 71%, specificity 96%;) and LVGCW (rest: AUC 0.82, sensitivity 87%, specificity 70%; peak: AUC 0.92, sensitivity 84%, specificity 87%;) than LVGLS (resting: AUC 0.79, sensitivity 61%, specificity 87%; peak: AUC 0.88, sensitivity of 77%, and specificity of 87%) have a higher value in the diagnosis of FD. Patients with FD have markedly lower LVGWI, LVGWE, and LVGCW compared to the healthy controls, and these reductions are more prominent during exercise. Although LVGWI and LVGCW increase during exercise in patients with FD, the rate of increase is reduced, indicating impaired myocardial metabolism and energy utilization efficiency, especially in patients with FD with LVH. Additionally, LVMW combined with Stress Echocardiography allows early detection of impaired cardiac function in Fabry patients.

BackgroundNoninvasive detection of coronary artery disease (CAD) with significant coronary stenosis by echocardiography remains challenging. Myocardial work (MW) is a noninvasive method for the quantitative assessment of left ventricular function, which, in combination with stress imaging, enables the detection of myocardial ischemia during myocardial stimulation. We aimed to preliminarily explore the diagnostic value of regional stress MW combined with coronary flow reserve (CFR) in identifying significant stenosis of the left anterior descending artery (LAD).MethodsA retrospective collection of 120 patients suspected of CAD with coronary angiography was performed, including 63 with nonsignificant stenosis in the LAD and 57 with significant stenosis in the LAD. In addition to conventional echocardiographic parameters, all individuals underwent stress echocardiography (SE) with pharmacological stress. We statistically compared longitudinal strain (LSLAD), peak strain dispersion (PSD), work index (WILAD), work efficiency (WELAD), and CFR before and after drug stress. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the univariate logistic regression model (ULRM) and multivariate logistic regression model (MLRM) in detecting significant stenosis in the LAD and myocardial ischemia. Decision curve analysis (DCA) was applied to evaluate the clinical net benefit of the best model and validate its robustness using an independent cohort.ResultsConventional echocardiographic parameters showed no significant difference between the nonsignificant and significant stenosis groups (P>0.05). Analysis of MW-related parameters showed that the group with nonsignificant stenosis differed from the group with significant stenosis. WILAD and WELAD were reduced in the significant stenosis group at rest (P<0.05). LSLAD, WILAD, and WELAD were reduced, and PSD was elevated in the significant stenosis group at peak stress (all P<0.05). Patients in the significant stenosis group had significantly lower CFR than those in the nonsignificant stenosis group (P<0.001). In univariate logistic regression, CFR had the largest AUC (0.837), with sensitivity and specificity of 0.634 and 0.791, respectively; among MW parameters, Peak WELAD had the largest AUC (0.825), with sensitivity and specificity of 0.902 and 0.581, respectively. Multivariate logistic regression showed that the best MLRM1 (AUC =0.889, sensitivity of 0.902, specificity of 0.721) and the most concise MLRM2 (AUC =0.857, sensitivity of 0.756, specificity of 0.884) demonstrated superior performance in predicting significant stenosis of the LAD and impairment of left ventricular function. DCA showed that the best MLRM1 provides higher net gains within a reasonable threshold. Furthermore, in the independent validation cohort, the best MLRM1 achieved an AUC of 0.888, suggesting excellent generalizability of the model.ConclusionsStress MW parameters and CFR demonstrated potential discriminatory ability for early myocardial ischemia caused by significant stenosis of LAD in this cohort. These results support the feasibility of exploring MLRM models that incorporate stress MW and CFR as noninvasive screening tools in future prospective studies.

This article demonstrates how the concept of preventable mortality can be used to develop mortality reduction measures using cardiovascular disease (CVD) as an example. The measures are structured according to Donabedian model. A Russian methodology for determining preventable mortality, based on international approaches and adapted to Russian healthcare system, was used. In collaboration with federal experts, a list of measures to reduce preventable cardiovascular mortality was developed. To systematize these measures, Donabedian’s triad was used, identifying resources, processes, and performance indicators for each measure. Following activity examples are presented: "health schools" using telemedicine technologies, individual patient information, and stress echocardiography. Their structuring according to the Donabedian model makes it possible to identify the causes of potentially unsatisfactory results and improve their implementation. Integrating the concept of preventable mortality with the Donabedian model ensures a rational selection and evaluation of measures to reduce cardiovascular mortality, as well as the effective allocation of resources. The list of activities requires regular updating, taking into account changes in medical technologies and healthcare system capabilities.

Heart failure remains a major global health challenge, characterized by high morbidity, mortality, and economic burden despite continuous advances in therapy. This review summarizes landmark clinical trials that have shaped current approaches to device therapy in heart failure, including implantable cardioverter-defibrillators, cardiac resynchronization therapy, and emerging conduction system pacing. In addition, it discusses novel prognostic and monitoring methods such as impedance cardiography and dobutamine stress echocardiography, which enable more precise patient assessment. Based on the available clinical data, we propose a new four-step decision algorithm for personalised device therapy selection in heart failure, integrating etiology-specific risk stratification, electrical and functional evaluation, and prognostic modifiers. The integration of evidence-based interventions and phenotype-driven decision-making supports a proactive and individualized approach to improving outcomes and quality of life in patients with heart failure.

CT Angiography-derived fractional flow reserve in the emergency department: Insights from a matched cohort analysis.

Prognostic Significance of Echocardiographic Transaortic Flow Rate in Aortic Valve Stenosis: A Systematic Review and Meta-Analysis.

Exercise stress echocardiography (ExSEC) is a well-established modality for evaluating coronary artery disease (CAD). In individuals with lower limb impairments, arm exercise stress echocardiography (Arm-ExSEC) represents a potential alternative; however, data supporting its predictive value are lacking. This study aimed to assess the diagnostic and prognostic utility of Arm-ExSEC for CAD detection in this population.A retrospective analysis was conducted on 68 patients with lower limb disabilities (47% male; mean age 67.6 ± 10.6 years) to evaluate the ability of Arm-ExSEC to detect CAD, as confirmed by coronary angiography, and to predict a composite outcome of myocardial infarction and cardiac mortality at 1-year follow-up.Arm-ExSEC demonstrated a sensitivity of 72%, specificity of 80%, and an overall accuracy of 76% for detecting CAD. Survival analysis showed a higher incidence of the primary outcome among patients with positive Arm-ExSEC compared to those with negative results (log-rank test, p = 0.007). In multivariable Cox-regression analysis adjusted for age and sex, a positive Arm-ExSEC remained independently associated with the primary outcome (hazard ratio [95% CI], 10.50 [1.20-91.93]; p = 0.034).These findings suggest that Arm-ExSEC may serve as a valuable modality for both the diagnostic and prognostic assessment of CAD in patients with lower limb impairments.

Cardiovascular diseases (CVD) are the primary causes of mortality in diabetic patients. Recent advances have demonstrated that stress echocardiography can assist in identifying early cardiovascular changes before the onset of symptoms. This research aims to identify early biomarkers of CVD utilizing stress echocardiography. Thirty patients diagnosed with type 2 diabetes mellitus were included in this study. All individuals exhibited no symptoms related to the cardiovascular system and maintained a preserved left ventricle (LV) ejection fraction. Initially, physical examinations, electrocardiogram, and routine echocardiography were conducted for patients. Subsequently, patients underwent evaluation via stress echocardiography following the administration of dobutamine. A significant relationship was observed between FBS levels and alterations in LV GLS at the peak of the stress echocardiography test. Nonetheless, no association was identified among the demographic information of the patients, such as gender, age, and BMI. There was no significant association between HbA1c, the duration of diabetes, and insulin consumption with the LV GLS index. A significant relationship exists between FBS levels and LV GLS. This finding highlights the usefulness of dobutamine stress echocardiography in identifying early cardiovascular changes before the onset of symptoms in diabetic patients with CVD. •Cardiovascular pathology in diabetes begins before symptoms presentation. •Poor glycemic control is associated with alterations in LV GLS. •Prevention of cardiovascular diseases should begin earlier than symptomatic disease.

Implementation of a High-Sensitivity Troponin Assay and Its Association With Resource Utilization in Patients With Suspected Acute Coronary Syndrome

Introduction: Hypertrophic cardiomyopathy (HCM) is a genetically mediated myocardial disorder with variable clinical expression and reduced functional capacity. Cardiopulmonary exercise testing when integrated with stress echocardiography (CPET-TTE), offers a comprehensive evaluation of cardiovascular performance. In this study, we aimed to assess the added value of CPET-TTE for risk stratification in HCM using a machine learning–based approach to identify individuals at higher risk for major adverse events Methods: We retrospectively analyzed 413 HCM patients (46% obstructive; 63.1% male; mean age 48.3 years) who underwent CPET with rest and stress echocardiography, 24-hour ECG Holter, cardiac MRI, and genetic testing. Several machine learning models were developed to predict a composite outcome (SCD, aborted SCD, heart transplantation, stroke, myocardial infarction), with Gradient Boosting using Cox proportional hazards loss achieving the best performance. A semi-supervised clustering approach applying k-means to out-of-fold risk scores was used to stratify patients into high- and low-risk groups. Feature importance was assessed using the Kruskal-Wallis test and ranked by -log10(p-value); effect sizes were quantified using eta-squared. Results: Gradient Boosting achieved the best predictive performance (C-index: 0.722). Survival analysis showed a clear separation between high-risk (n = 56, 30.4% events) and low-risk (n = 357, 10.1% events) groups (p &lt; 0.000001). High-risk patients were older (56.0 vs 49.0 years) and had significantly reduced exercise capacity (VO2max%: 49.8% vs 68.0%; AT%: 41.3% vs 55.5%; pVO2: 15.1 vs 19.7 ml/kg/min), greater ventilatory inefficiency (VE/VCO2: 29.0 vs 26.5), lower watt ( 80.0 vs 100.0 W), and oxygen pulse (HR/VO2: 9.7 vs 11.4).No significant differences were observed in rest or peak LVOT gradient (14.5 vs 11.0 mmHg; 31.0 vs 30.0 mmHg) or E/e′ ratio at rest (11.7 vs 11.2) and stress (11.4 vs 10.3). Key features contributing to risk prediction included VO2max%, AT%, pVO2 and VE/VCO2 slope (all p &lt; 0.001). Conclusion: The integration of CPET-TTE parameters with advanced machine learning techniques allowed for effective and clinically relevant risk stratification in patients with hypertrophic cardiomyopathy.. These findings highlight the central prognostic value of exercise capacity and ventilatory efficiency in HCM, supporting the routine use of CPET-TTE as a non-invasive, functional tool for personalized risk assessment.

Introduction: Despite its increasing prevalence and significant morbidity/mortality in the aging population, heart failure with preserved ejection fraction (HFpEF) remains challenging to diagnose as its symptoms may occur only during exercise. In smaller studies, non-invasive diastolic stress testing has been validated in diagnosing exercise-induced increase in diastolic filling pressures. However, its feasibility in a large real-world population has not been tested. Aims: The Dallas Heart Study is a multiethnic, probability-based, population cohort study of Dallas County residents with deliberate oversampling of black individuals. The study sample consisted of 712 participants with LVEF≥50% and free of prevalent HF who attended the 3 rd phase of the Dallas Heart Study (2021-2024) and underwent diastolic stress echocardiography. Methods: Participants underwent comprehensive resting echo followed by a submaximal stress echo protocol which includes pedaling on a supine echocardiography bicycle at a fixed workload of 30W. Per 2016 stress echocardiography recommendations by the American Society of Echocardiography (ASE), a definitive abnormal test was defined when the following criteria are met: septal E/e′ ratio&gt;15, average E/e′&gt;14, peak TR velocity&gt;2.8 m/s with exercise, and either septal e′&lt;7 or lateral e′&lt;10 cm/s at rest. Results: Mean age was 59±11 years, and 56% were women ( Table 1 ). 48% of the participants were Black, 32% White, and 18% Hispanic. Mean BMI was 31±7 kg/m 2 , 23% had diabetes, and 59% had hypertension. Between rest and stress ( Table 2 ), there were statistically significant increases in LVEF, LV GLS, e’, mean E/e’, peak TR velocity, LA volume index, and LA reservoir strain. At rest, 5% of the participants had abnormal E/e’ (defined as &gt;14), while at stress 8% did. To identify predictors of abnormal E/e’, backwards (P &lt;0.001) multivariable stepwise regression modeling was performed on baseline demographics and resting echo variables and found lateral E/e’ as the only independent predictor (OR 1.86, 95% CI 1.40-2.46). Notably, 2% of the participants were found to have a definite abnormal diastolic stress test per ASE recommendation. Conclusion: We have demonstrated the feasibility of performing non-invasive diastolic stress testing on a large contemporary real-world cohort. With rapidly emerging HFpEF therapies, more widespread adoption of an effective and safe diagnostic tool for HFpEF is needed to warrant adequate and individualized treatment.

Introduction: Women with chest pain but no obstructive coronary artery disease (oCAD) may have coronary microvascular dysfunction (CMD), which is linked to ischemia, increased cardiovascular risk, and reduced quality of life (QoL). Psychological factors such as anxiety, depression, and stress may further impair functioning in both obstructive and non-obstructive groups, but their role in women with CMD remains understudied. We evaluated psychosocial and health-related QoL in postmenopausal women with CMD, oCAD, and healthy controls. Methods: Postmenopausal women with chest pain (n=50) were enrolled in two separate groups: oCAD (n=13; &gt;50% stenosis), CMD (n=14; non-obstructive CAD with coronary flow reserve &lt;2.5 or index of microcirculatory resistance &gt;25), and a third group was included as healthy controls (n=23; no cardiac history, medications, or abnormal stress tests). Participants completed baseline assessments of demographics, cardiovascular risk factors, and validated psychosocial and QoL measures. Depression was assessed using the Beck Depression Inventory (BDI; 0–63), anxiety using the State-Trait Anxiety Inventory (STAI; 20–80), perceived stress using the Perceived Stress Scale (PSS-14; 0–56), and PTSD symptoms using the PCL-5 (0–80). Higher scores reflected greater symptom severity. Health-related QoL was measured across eight domains with the Short Form-36 (SF-36; 0–100); higher scores indicated better functioning. ANOVA and chi square analysis were done to compare variables across 3 groups. Linear regression model was applied to assess the difference among groups using control as a reference. Results: The mean age was 62 ± 10 years. Baseline characteristics were comparable across groups. CMD patients showed more depressive symptoms, PTSD symptoms, and perceived stress ( p ≤ 0.04) and worse SF-36 scores compared to controls in physical functioning, role limitations–physical, energy/fatigue, social functioning, pain, and general health ( all p ≤ 0.01) depicting marked impairments whereas oCAD did not differ from controls-highlighting the distinct functional and psychological burden of CMD. Conclusions: Women with CMD experience greater impairments in physical and psychosocial functioning than both healthy controls and oCAD. These findings underscore the overlooked burden of CMD and the need for targeted interventions addressing quality of life and mental health in this at-risk population.