In a recent retrospective analysis, ultrafast non-ECG-gated cardiac spectral CT performed on a Philips Spectral CT 7500 system was compared with conventional cardiac CT protocols and demonstrated several technical advantages. Specifically, acquisition time was significantly shorter (median 0.69 s vs 8.02 s, P < 0.001), and radiation exposure was markedly reduced, with lower CTDIvol (7.2 mGy vs 29.6 mGy) and dose-length product (211.0 vs 477.6 mGy*cm, P < 0.001). Image quality was consistently better, with an approximately 50% increase in signal-to-noise ratio. Myocardial extracellular volume (ECV) quantification derived from spectral CT showed good interobserver reproducibility in normal myocardium and excellent agreement in areas with late iodine enhancement (LIE), with negligible bias. In the subset of patients who also underwent cardiac MRI (CMR), the LIE and ECV values obtained from spectral CT showed good concordance with late gadolinium enhancement and T1-mapping–derived ECV, supporting the validity of CT-based tissue characterization. Overall, these results support ultrafast cardiac spectral CT as a technically robust alternative for myocardial tissue characterization, particularly in patients with high heart rates, limited ECG-gating feasibility, or contraindications to CMR, while maintaining high image quality and minimal motion artifacts.