Cardiac amyloid radionuclide imaging: Global perspective and future priorities

Transthyretin amyloid cardiomyopathy (ATTR-CM) has transitioned from a rare, untreatable condition to a prevalent and treatable cause of heart failure, driven by advances in disease-modifying therapies and the emergence of cardiac amyloid radionuclide imaging (CARI) as a reliable noninvasive diagnostic modality. Despite widespread adoption, substantial global heterogeneity persists in access, technical implementation, and diagnostic performance for CARI. This review synthesizes contemporary evidence on the global state of CARI, highlighting regional disparities in infrastructure, referral patterns, and adherence to best-practice standards. Furthermore, the review proposes a set of pragmatic strategies to enhance global CARI implementation, including standardized protocols prioritizing SPECT-based interpretation, targeted education, clearer guidance for screening high-risk populations, and development of international registries. Addressing these barriers is essential to ensure equitable, high-quality diagnosis and to fully realize the clinical impact of CARI in ATTR-CM.