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Diagnostics
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Echocardiography in the Intensive Care Unit
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Echocardiography in the Intensive Care Unit

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 4459

Editor

Prof. Dr. Carlo Caiati

E-Mail
Guest Editor
Cardiovascular Division, University of Bari, 70123 Bari, Italy
Interests: cardiomyopathy; prognosis; echocardiography; systolic and diastolic cardiac function; long term outcome; cardiac transplantation; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As a non-invasive imaging modality, echocardiography is a vital tool in the intensive care setting, which provides a real-time assessment of cardiac function, hemodynamics, and structural abnormalities. This Special Issue entitled "Echocardiography in the Intensive Care Unit" aims to bring together articles on cutting-edge research and clinical applications of echocardiography in the ICU. Articles may cover topics such as the use of echocardiography for early diagnosis of coronary artery disease, assessment of myocardial ischemia and viability, and monitoring of cardiac function in patients with sepsis, shock, and acute respiratory distress syndrome, etc. We believe it will contribute to the continued advancement of echocardiography practice in the intensive care setting, providing new insights for clinicians and researchers.

Prof. Dr. Carlo Caiati
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • echocardiography
  • intensive care unit (ICU)
  • critical care
  • cardiac function
  • coronary artery disease
  • sepsis
  • shock

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Published Papers (3 papers)

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Research

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15 pages, 1569 KB  
Article
Characterisation of Post-Sepsis Cardiomyopathy Using Cardiovascular Magnetic Resonance
by Samuel Malomo, Thomas Oswald, Edward Stephenson, Anthony Yip, Thomas Alway, Stanislav Hadjivassilev, Steven Coombs, Susan Ellery, Joon Lee, Rachael James, Claire Phillips, Barbara Philips, David Hildick-Smith, Victoria Parish and Alexander Liu
Diagnostics 2025, 15(8), 997; https://doi.org/10.3390/diagnostics15080997 - 14 Apr 2025
Cited by 12 | Viewed by 2362
Abstract
Background: Post-sepsis cardiomyopathy is associated with an increased risk of adverse cardiovascular outcomes. It remains poorly understood, which limits therapeutic development. This study characterised post-sepsis cardiomyopathy using cardiovascular magnetic resonance (CMR) imaging. Methods: Patients admitted with acute sepsis and suspected cardiac injury or [...] Read more.
Background: Post-sepsis cardiomyopathy is associated with an increased risk of adverse cardiovascular outcomes. It remains poorly understood, which limits therapeutic development. This study characterised post-sepsis cardiomyopathy using cardiovascular magnetic resonance (CMR) imaging. Methods: Patients admitted with acute sepsis and suspected cardiac injury or heart failure who subsequently (47 days [IQR: 22–122]) underwent CMR at a UK tertiary cardiac centre were included. Age- and gender-matched controls (n = 16) were also included. Subjects underwent CMR at 1.5 Tesla with cines, native T1- and T2-mapping, and late gadolinium enhancement (LGE) imaging. Results: Of the 22 post-sepsis patients (age 50 ± 13 years; 64% males), 13 patients (59%) had left ventricular (LV) dilatation. Patients had significantly elevated left ventricular (LV) end-diastolic and end-systolic volume indices compared to controls (p = 0.011 and p = 0.013, respectively). Eleven patients (50%) had LV systolic dysfunction (ejection fraction < 50%), most of whom (8/11) had non-ischaemic patterns of LGE (n = 7 mid-wall; n = 1 mid-wall/patchy). In the eleven patients with preserved LV systolic function (ejection fraction ≥ 50%), three patients (27%) had significant LGE (n = 1 mid-wall; n = 1 subepicardial/mid-wall; n = 1 patchy). Compared to controls, patients had elevated septal native myocardial T1 values (p < 0.001) but similar septal native myocardial T2 values (p = 0.090), suggesting the presence of myocardial fibrosis without significant oedema. Conclusions: Post-sepsis cardiomyopathy is characterised by LV dilatation, systolic dysfunction, and myocardial fibrosis in a non-ischaemic distribution. Significant myocardial oedema is not prominent several weeks post-recovery. Further work is needed to test these findings on a multi-centre basis and to develop novel therapies for post-sepsis cardiomyopathy. Full article
(This article belongs to the Special Issue Echocardiography in the Intensive Care Unit)
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Review

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18 pages, 849 KB  
Review
Beyond the Spontaneous Breathing Trial: Echocardiographic and Integrated Ultrasound Assessment During Weaning from Mechanical Ventilation
by Saeed Torabi and Philipp K. Omuro
Diagnostics 2026, 16(11), 1709; https://doi.org/10.3390/diagnostics16111709 - 2 Jun 2026
Viewed by 607
Abstract
Background/Objectives: Weaning failure from mechanical ventilation affects 10–20% of critically ill patients. Cardiovascular dysfunction—particularly diastolic dysfunction with elevated left atrial pressure (LAP)—underlies up to 50–60% of failed spontaneous breathing trials (SBTs) and frequently remains undetected without targeted echocardiographic assessment. This narrative review synthesises [...] Read more.
Background/Objectives: Weaning failure from mechanical ventilation affects 10–20% of critically ill patients. Cardiovascular dysfunction—particularly diastolic dysfunction with elevated left atrial pressure (LAP)—underlies up to 50–60% of failed spontaneous breathing trials (SBTs) and frequently remains undetected without targeted echocardiographic assessment. This narrative review synthesises current evidence on the echocardiographic evaluation of weaning failure, with emphasis on LAP estimation, right ventricular (RV) dysfunction, and the integration of lung and diaphragm ultrasound. Methods: A structured literature search of PubMed/MEDLINE and EMBASE was performed for publications from January 2000 to April 2026, supplemented by hand-searching of reference lists and current society guidelines. This article is reported as a narrative review; no formal systematic review protocol was registered. A qualitative synthesis emphasising pathophysiological mechanisms, echocardiographic phenotypes, and clinical applicability was performed. Results: Positive pressure ventilation with PEEP provides active LV afterload reduction; extubation abruptly removes this unloading and may precipitate acute filling pressure elevation in vulnerable patients. Multiparametric echocardiographic LAP assessment—integrating the E/e’ ratio, deceleration time, and pulmonary vein flow—supports pre-extubation risk stratification. The dynamic PEEP reduction test, although not yet standardised or multicentre-validated, may identify patients with load-dependent cardiac decompensation before extubation. RV dysfunction is present in 20–50% of ventilated patients and worsens weaning outcomes through ventricular interdependence. Complementary lung ultrasound B-line quantification and diaphragm thickening fraction assessment together support a phenotype-specific diagnostic approach. Conclusions: A structured multimodal ultrasound framework integrating echocardiography, lung ultrasound, and diaphragm ultrasound may support identification and targeted treatment of the dominant mechanism of weaning failure before extubation. Prospective multicentre validation of the integrated protocol as a whole remains a priority research need. Full article
(This article belongs to the Special Issue Echocardiography in the Intensive Care Unit)
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20 pages, 658 KB  
Review
Septic Cardiomyopathy in the ICU: Echocardiographic Phenotypes, Global Longitudinal Strain, and Right Ventricular Assessment
by Saeed Torabi, Philipp K. Omuro, Elisabeth H. Adam and Tobias Kammerer
Diagnostics 2026, 16(11), 1664; https://doi.org/10.3390/diagnostics16111664 - 28 May 2026
Viewed by 815
Abstract
Background/Objectives: Septic cardiomyopathy (SC) is a frequent and clinically relevant complication of sepsis, characterized by acute, typically reversible myocardial dysfunction in the absence of primary coronary artery disease. Its clinical presentation is highly heterogeneous, and conventional diagnostic parameters frequently fail to capture the [...] Read more.
Background/Objectives: Septic cardiomyopathy (SC) is a frequent and clinically relevant complication of sepsis, characterized by acute, typically reversible myocardial dysfunction in the absence of primary coronary artery disease. Its clinical presentation is highly heterogeneous, and conventional diagnostic parameters frequently fail to capture the full extent of cardiac impairment. This narrative review aims to synthesize current evidence on the echocardiographic assessment of SC, with a focused emphasis on global longitudinal strain (GLS), right ventricular (RV) dysfunction, and diastolic impairment, and to discuss their prognostic and therapeutic implications. Methods: A comprehensive literature search was performed in PubMed/MEDLINE for publications between 2010 and March 2026, supplemented by seminal historical studies. A second, structured literature search was performed in PubMed/MEDLINE for publications between 2010 and April 2026, supplemented by seminal historical studies. Eligible study types included original research articles, systematic reviews, meta-analyses, and clinical guidelines. The search and selection workflow followed the principles of PRISMA-ScR. A qualitative narrative synthesis was performed. Results: SC encompasses distinct echocardiographic phenotypes—global hypokinesia, hyperdynamic function, RV dysfunction, and diastolic impairment—each carrying specific pathophysiological and prognostic implications. Left ventricular ejection fraction (LVEF) is highly load-dependent and may be misleading in vasoplegic states. GLS derived from speckle-tracking echocardiography defects may detect subclinical myocardial dysfunction earlier than LVEF, and provides independent prognostic information in observational studies. RV dysfunction occurs in 20–50% of sepsis patients and represents a powerful robust independent predictor of mortality. Diastolic dysfunction Grade ≥ 2 is independently associated with adverse outcomes through elevated filling pressures and reduced cardiac reserve. Conclusions: A multiparametric echocardiographic approach integrating LVEF, GLS, RV function indices, and diastolic parameters is essential and may improve the accurate phenotyping and hemodynamic management of SC. Structured diagnostic algorithms, expert-based diagnostic frameworks incorporating these tools which may facilitate phenotype-guided therapy and improve clinical outcomes, are proposed to facilitate phenotype-guided therapy; their impact on patient outcomes warrants confirmation in prospective multicenter studies. Full article
(This article belongs to the Special Issue Echocardiography in the Intensive Care Unit)
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