[Chronic coronary syndrome : advanced cardiac imaging]

Cardiovascular diseases remain the leading cause of mortality worldwide. Chronic coronary syndrome is now recognized as an evolving and heterogeneous condition that involves both epicardial disease and microvascular dysfunction. Many patients present symptoms, with or without documented ischemia, in the absence of obstructive stenosis, underscoring its pathophysiological complexity. Noninvasive imaging modalities demonstrate strong diagnostic performance. Current guidelines advocate a patient-centered diagnostic strategy guided by pretest probability and clinical characteristics. While CT refines anatomical evaluation and plaque characterization, PET provides a comprehensive ischemia assessment and quantitative myocardial blood flow analysis, delivering incremental and independent prognostic information and enabling personalized risk stratification.