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Diagnostics
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Recent Advances in Echocardiography, 2nd Edition
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Recent Advances in Echocardiography, 2nd Edition

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

Deadline for manuscript submissions: 28 February 2026 | Viewed by 6967

Special Issue Editor

Dr. Giulia Elena Mandoli

E-Mail Website
Guest Editor
Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
Interests: echocardiography; heart failure; atrial fibrillation; chronic heart failure; cardiac function; clinical cardiology; hypertension; cardiac echocardiography; acute heart failure; cardiac imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Echocardiography has undergone significant advancements in recent years, revolutionizing the diagnosis, management, and follow-up procedures for various cardiovascular conditions. One noteworthy achievement in echocardiography is the emergence of novel imaging technologies that enhance the visualization of cardiac structures and functions. These include three-dimensional echocardiography, speckle tracking echocardiography, and contrast-enhanced echocardiography, which have greatly improved the accuracy and diagnostic capabilities. Additionally, the integration of artificial intelligence and machine learning techniques has the potential to further enhance image analysis and interpretation, aiding in the early detection of cardiovascular diseases.

Recent developments in echocardiography have paved the way for its utilization in novel clinical scenarios, such as the assessment of myocardial strain, cardiac mechanics, and tissue characterization. These advancements have propelled echocardiography beyond the traditional role of evaluating structural abnormalities, enabling clinicians to learn about functional aspects of the heart. With ongoing research and technological advancements, it is expected that echocardiography will continue to evolve, delivering an even more exquisite imaging quality, greater diagnostic accuracy, and improved portability. By shedding light on the continual evolution of this invaluable imaging modality, we aim to inspire future research, collaboration, and innovation, ultimately nurturing better cardiovascular health outcomes for patients worldwide.

Dr. Giulia Elena Mandoli
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-blind 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

  • standard echocardiography
  • speckle tracking echocardiography
  • strain
  • myocardial deformation
  • 3D echocardiography
  • valvular reconstruction
  • differential diagnosis
  • artificial intelligence

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Published Papers (5 papers)

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Research

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17 pages, 2368 KB  
Article
Validation of a Manual Method for Measuring Left Atrial Reservoir Strain Against Automated Speckle Tracking Analysis
by Marina Leitman and Vladimir Tyomkin
Diagnostics 2025, 15(16), 2073; https://doi.org/10.3390/diagnostics15162073 - 19 Aug 2025
Viewed by 1293
Abstract
Background: Left atrial strain, particularly reservoir strain, has emerged as a sensitive marker of left atrial function and an early indicator of diastolic dysfunction and cardiovascular risk. However, automated left atrial strain analysis is not universally available, particularly in resource-limited settings. In this [...] Read more.
Background: Left atrial strain, particularly reservoir strain, has emerged as a sensitive marker of left atrial function and an early indicator of diastolic dysfunction and cardiovascular risk. However, automated left atrial strain analysis is not universally available, particularly in resource-limited settings. In this study, we propose a manual method for calculating biplane left atrial reservoir strain and validate its agreement with automated software in patients with atrial fibrillation and in sinus rhythm. Methods: Echocardiography examinations from 30 patients with atrial fibrillation and 30 patients in sinus rhythm were analyzed. Left atrial reservoir strain was calculated using both an automatic speckle tracking imaging-based algorithm and a manual point-by-point method based on atrial wall delineation. Agreement between methods was assessed using Pearson correlation, Bland–Altman analysis, and intraclass correlation coefficient. Results: Strong correlation and excellent agreement were observed between the two methods in both groups. Pearson correlation coefficients were r = 0.95 (p < 0.0001) in the atrial fibrillation group and r = 0.94 (p < 0.0001) in the sinus rhythm group. Bland–Altman analysis showed narrow limits of agreement, particularly in the atrial fibrillation group. The intraclass correlation coefficient was 0.95 in atrial fibrillation and 0.92 in sinus rhythm, indicating excellent reliability. The standard error of measurement and minimal detectable change were low in both groups. Conclusions: Manual measurement of left atrial reservoir strain is feasible, reproducible, and demonstrates excellent agreement with automated software. It may serve as a reliable alternative in clinical scenarios where automated tools are unavailable. Full article
(This article belongs to the Special Issue Recent Advances in Echocardiography, 2nd Edition)
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13 pages, 879 KB  
Article
Three-Dimensional Speckle Tracking Echocardiography for Detection of Acute Coronary Occlusions in Non-ST-Elevation Acute Coronary Syndrome Patients
by Thomas M. Stokke, Kristina H. Haugaa, Kristoffer Russell, Thor Edvardsen and Sebastian I. Sarvari
Diagnostics 2025, 15(15), 1864; https://doi.org/10.3390/diagnostics15151864 - 25 Jul 2025
Viewed by 731
Abstract
Objectives: This study aimed to evaluate the ability of three-dimensional (3D) speckle tracking echocardiography (STE) to detect acute coronary occlusions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its potential diagnostic advantage over two-dimensional (2D) STE. Methods: Fifty-six patients [...] Read more.
Objectives: This study aimed to evaluate the ability of three-dimensional (3D) speckle tracking echocardiography (STE) to detect acute coronary occlusions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its potential diagnostic advantage over two-dimensional (2D) STE. Methods: Fifty-six patients with NSTE-ACS (mean age 64 ± 11 years; 80% male) underwent 2D and 3D transthoracic echocardiography prior to coronary angiography. Global longitudinal strain (GLS), global circumferential strain (GCS), and 3D ejection fraction (EF) were analyzed. Acute coronary occlusion was defined as TIMI flow 0–1 in the presumed culprit artery. Results: Acute coronary occlusion was present in 16 patients (29%). Patients with occlusion had significantly more impaired strain compared to those without: 3D GLS (−12.5 ± 2.7% vs. −15.5 ± 2.1%, p < 0.001), 2D GLS (−12.6 ± 2.8% vs. −15.6 ± 2.0%, p < 0.001), 3D GCS (−24.8 ± 4.4% vs. −27.8 ± 4.3%, p = 0.02), and 2D GCS (−18.1 ± 5.5% vs. −22.9 ± 4.7%, p = 0.002). In contrast, 3D EF did not differ significantly between groups (52.5 ± 4.7% vs. 54.7 ± 5.7%, p = 0.16). Receiver operating characteristic analysis showed that 3D and 2D GLS had the highest diagnostic performance (AUCs 0.81 and 0.78), while 3D EF had the lowest (AUC 0.61). Feasibility was lower for 3D STE (86%) than for 2D longitudinal strain (95%, p = 0.03). Conclusions: Both 3D and 2D GLS showed higher diagnostic accuracy than 3D EF in identifying acute coronary occlusion in NSTE-ACS patients. While 3D STE enables simultaneous assessment of multiple parameters, it did not offer incremental diagnostic value over 2D STE and had lower feasibility. Full article
(This article belongs to the Special Issue Recent Advances in Echocardiography, 2nd Edition)
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Review

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12 pages, 911 KB  
Review
Multimodality Assessment for Durable Mechanical Circulatory Support Implantation
by Luca Martini, Antonio Pagliaro, Francesca Maria Righini, Massimo Mapelli, Cristina Madaudo, Nicolò Ghionzoli, Carlotta Sciaccaluga, Sonia Bernazzali, Massimo Maccherini, Serafina Valente, Giulia Elena Mandoli, Antonio Luca Maria Parlati and Matteo Cameli
Diagnostics 2025, 15(22), 2886; https://doi.org/10.3390/diagnostics15222886 - 14 Nov 2025
Viewed by 573
Abstract
The prevalence of advanced heart failure (AdHF) is increasing globally, driven by population aging and improved survival rates in chronic heart failure (CHF). Durable Mechanical Circulatory Support (DMCS), particularly Left Ventricular Assist Devices (LVADs), has become a cornerstone in AdHF management. However, its [...] Read more.
The prevalence of advanced heart failure (AdHF) is increasing globally, driven by population aging and improved survival rates in chronic heart failure (CHF). Durable Mechanical Circulatory Support (DMCS), particularly Left Ventricular Assist Devices (LVADs), has become a cornerstone in AdHF management. However, its successful implantation requires a comprehensive preoperative evaluation integrating cardiac, hemodynamic, and systemic assessments. Echocardiography and cardiac magnetic resonance (CMR) provide critical data for risk stratification—e.g., LV ejection fraction < 25%, LV end-diastolic diameter < 60 mm, or free wall RV longitudinal strain (fwRVLS) > −14% predict poorer outcomes. Right heart catheterization (RHC) identifies hemodynamic contraindications (PVR > 6 WU, PAPi < 1.5, cardiac index < 2 L/min/m2), while cardiopulmonary exercise testing (CPET) remains pivotal for assessing functional reserve (peak VO2 < 12 mL/kg/min or <50% predicted). Systemic assessment must address renal, hepatic, oncologic, and psychiatric comorbidities that influence surgical risk. Integrating these multimodal data within a multidisciplinary framework—spanning cardiologists, cardiac surgeons, anesthesiologists, and psychologists—optimizes selection and outcomes for DMCS candidates. Full article
(This article belongs to the Special Issue Recent Advances in Echocardiography, 2nd Edition)
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26 pages, 2648 KB  
Review
The Contribution of Echocardiography to the Diagnosis and Prognosis Stratification of Diabetic Cardiomyopathy
by Maria Ioannou, Dimitrios Karelas, Alkistis Eleni Kalesi, Georgios Parpas, Christos A. Papanastasiou, Constantinos H. Papadopoulos, Angeliki Mouzarou and Nikolaos P. E. Kadoglou
Diagnostics 2025, 15(20), 2587; https://doi.org/10.3390/diagnostics15202587 - 14 Oct 2025
Viewed by 894
Abstract
The relationship of diabetes mellitus (DM) with cardiovascular mortality and morbidity has been widely established. Diabetic cardiomyopathy (DBCM) has been increasingly recognized as the development of cardiac dysfunction accompanied by heart failure (HF) symptoms in the absence of obvious causes like coronary artery [...] Read more.
The relationship of diabetes mellitus (DM) with cardiovascular mortality and morbidity has been widely established. Diabetic cardiomyopathy (DBCM) has been increasingly recognized as the development of cardiac dysfunction accompanied by heart failure (HF) symptoms in the absence of obvious causes like coronary artery disease (CAD), hypertension (HTN) or valvular diseases. The objective of this review is to critically appraise the role of echocardiography in the diagnosis and prognostic stratification of DBCM. Echocardiography remains the first-line imaging modality due to its availability, repeatability, non-invasive nature and ability to assess structural and functional changes. Classical echocardiographic indices such as left ventricular hypertrophy and systolic and diastolic dysfunction assessment provide valuable information but they lack sensitivity, often remaining normal until advanced stages of DBCM. Recently developed echocardiographic modalities, including strain imaging, myocardial work indices and left atrial strain, may allow for earlier detection of subclinical myocardial dysfunction, having important prognostic implications. However, these advanced modalities require high imaging quality, expertise and standardization, being subject to technical and physio-logical limitations. Stress echocardiography, particularly exercise-based protocols, is an increasingly recognized, valuable tool for unmasking exertional abnormalities in filling pressures, myocardial reserve and pulmonary pressures that are not evident at rest. Until now, stress echocardiography requires validation in large cohorts to assess its prognostic power. This review highlights the importance of timely recognition of DBCM, underscores the advantages and disadvantages of current echocardiographic approaches and outlines future perspectives in multimodality imaging to improve patient outcomes. Full article
(This article belongs to the Special Issue Recent Advances in Echocardiography, 2nd Edition)
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20 pages, 712 KB  
Review
Global Longitudinal Strain in Stress Echocardiography: A Review of Its Diagnostic and Prognostic Role in Noninvasive Cardiac Assessment
by Nikolaos Antoniou, Sotiria Iliopoulou, Dimitrios G. Raptis, Orestis Grammenos, Maria Kalaitzoglou, Marianthi Chrysikou, Christos Mantzios, Panagiotis Theodorou, Ioannis Bostanitis, Dafni Charisopoulou and George Koulaouzidis
Diagnostics 2025, 15(16), 2076; https://doi.org/10.3390/diagnostics15162076 - 19 Aug 2025
Cited by 1 | Viewed by 2955
Abstract
Background: The integration of global longitudinal strain (GLS) with stress echocardiography (SE) represents a significant advancement in non-invasive cardiac diagnostics, particularly in the evaluation of coronary artery disease (CAD). GLS, derived from speckle-tracking echocardiography, quantifies myocardial deformation and offers superior sensitivity for detecting [...] Read more.
Background: The integration of global longitudinal strain (GLS) with stress echocardiography (SE) represents a significant advancement in non-invasive cardiac diagnostics, particularly in the evaluation of coronary artery disease (CAD). GLS, derived from speckle-tracking echocardiography, quantifies myocardial deformation and offers superior sensitivity for detecting subclinical myocardial dysfunction compared to conventional metrics like wall motion and ejection fraction. Recent studies have validated the prognostic and diagnostic efficacy of GLS both at rest and during stress, notably enhancing the detection of obstructive and non-obstructive CAD, microvascular dysfunction, and other cardiac pathologies. Methods: This manuscript synthesizes extensive clinical data demonstrating the added value of GLS during stress echocardiography across diverse cardiac conditions—including valvular heart disease, heart failure, cardio-oncology, and pediatric cardiology. Novel metrics like longitudinal strain reserve (LSR), myocardial work indices, and post-systolic strain have further enriched risk stratification strategies. Results: The combination of GLS with SE has been shown to approximate the accuracy of invasive coronary angiography in intermediate-risk patients and in cases with equivocal traditional SE findings. Despite its clinical promise, the utility of GLS is challenged by technical limitations, including image quality dependency, inter-vendor variability, and limited applicability during high heart rate states. Conclusions: As technological refinement and standardization progress, GLS integrated with SE is poised to become a mainstay in precision cardiology, improving diagnostic yield, guiding therapeutic decisions, and enhancing patient outcomes. Full article
(This article belongs to the Special Issue Recent Advances in Echocardiography, 2nd Edition)
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