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Recent Developments and Emerging Trends of Echocardiography in Cardiac Disease
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Recent Developments and Emerging Trends of Echocardiography in Cardiac Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (25 November 2025) | Viewed by 3897

Special Issue Editor

Dr. Petri Gudmundsson

E-Mail Website
Guest Editor
Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö 205 06, Sweden
Interests: echocardiography; learning echocardiography; echocardiography in athletes; non-invasive outpatient diagnostics

Special Issue Information

Dear Colleagues,

Echocardiography—what a fascinating history and development. Starting with oscilloscope registrations in the heart using ultrasound equipment made for weld joint examination in the Swedish shipping industry, through groundbreaking discoveries of Doppler, m-mode, 2D, 3D, color Doppler, tissue Doppler, Speckle Tracking, Contrast-, Stress-, Transesophageal-Echo, GLS… to where we are today. Still in a swift, mobile, non-invasive, and harmless device, close to the patient. All this has contributed to clinical use, which has helped billions and saved or prolonged the lives of millions of people around the world.

Echocardiography has managed to find new areas of diagnostic contributions in both acute and chronic heart disease but has also tried to answer questions beyond its capability. It is also accused of being too user-dependent and using too subjective measurements and evaluations, which in turn has resulted in more objective and quantitative tools. Hence, echocardiography has developed into a valuable, world-wide, non-invasive diagnostic one-stop-tool to receive multiple answers or indications of both cause and effect as well as reliable recommendations of treatments. Inventions and discoveries in echocardiography have surprised us before and might do it in the future. Still, it is relevant to ask if echocardiography has peaked in its use or if there are still more to come behind creative scientific corners.

In this Special Issue, we aim to present scientific results and appetizers from some of the brightest minds in the field and try to give an overview of the latest developments and the current best ways to use echocardiography, as well as emerging trends that we should look out for and maybe even engage in.

Dr. Petri Gudmundsson
Guest Editor

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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 development
  • artificial intelligence (AI) integration
  • real-time 3D and 4D imaging
  • portable and handheld devices
  • contrast-enhanced imaging
  • tissue characterization
  • integration with other modalities
  • quantitative analysis
  • tele-echocardiography

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Published Papers (4 papers)

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Research

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13 pages, 1551 KB  
Article
The Aortic Flow Reversal Ratio: A Quantitative Adjunct to the Bicêtre Score in Vein of Galen Malformation
by Menachem Rimler, Ranjit Philip, Lydia Tanner, Hannah Huth and Lucas Elijovich
J. Clin. Med. 2026, 15(2), 748; https://doi.org/10.3390/jcm15020748 - 16 Jan 2026
Viewed by 410
Abstract
Background/Objectives: The Bicêtre score for Vein of Galen Aneurysmal Malformation (VGAM) relies on existing end-organ damage. We hypothesized that transthoracic echocardiography (TTE) could quantify significant systemic steal in clinically stable neonates (Bicêtre score ≥ 12). This study evaluates the Aortic Flow Reversal Ratio [...] Read more.
Background/Objectives: The Bicêtre score for Vein of Galen Aneurysmal Malformation (VGAM) relies on existing end-organ damage. We hypothesized that transthoracic echocardiography (TTE) could quantify significant systemic steal in clinically stable neonates (Bicêtre score ≥ 12). This study evaluates the Aortic Flow Reversal Ratio (AoFRr) as a tool to measure this steal and predict treatment outcomes. Methods: In a single-center retrospective study of patients with VGAM, the AoFRr (the ratio of the diastolic reversal velocity time integral to the systolic forward volume time integral) was calculated via TTE in the abdominal aorta at the level of the diaphragm before and after endovascular embolization. Over the study period, the cohort underwent a total of 30 endovascular interventions and 49 TTEs. Pre-intervention AoFRr was correlated with the Bicêtre score, and post-intervention changes were analyzed for association with the need for subsequent embolizations. Results: In a cohort of 12 patients with a median Bicêtre score of 18, 83.3% had pre-intervention aortic diastolic flow reversal. The median pre-intervention AoFRr was 0.81, indicating substantial systemic steal despite clinical stability. A post-intervention AoFRr reduction of ≥85% was significantly associated with a lower likelihood of requiring re-intervention (p = 0.0253). Conclusions: The AoFRr quantifies substantial hemodynamic steal in VGAM patients who appear clinically stable by the Bicêtre score. Its reduction following embolization predicts a more favorable clinical course. The AoFRr is a valuable, non-invasive adjunct for risk stratification and may help optimize the timing of endovascular intervention. Full article
(This article belongs to the Special Issue Recent Developments and Emerging Trends of Echocardiography in Cardiac Disease)
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13 pages, 862 KB  
Article
Effect of Food Intake on Vortex Formation Time as a Measurement of Diastolic Left Ventricular Function
by Sarah Smith, Andreas Malmgren, Ylva Gårdinger, Joanna Hlebowicz and Magnus Dencker
J. Clin. Med. 2025, 14(16), 5783; https://doi.org/10.3390/jcm14165783 - 15 Aug 2025
Viewed by 747
Abstract
Objectives: The aim of the present study was to assess if vortex formation time (VFT) as a measurement of left ventricular (LV) diastolic function is affected by food intake and related to age and sex. Methods: Healthy participants were divided into two age [...] Read more.
Objectives: The aim of the present study was to assess if vortex formation time (VFT) as a measurement of left ventricular (LV) diastolic function is affected by food intake and related to age and sex. Methods: Healthy participants were divided into two age groups: younger (median age: 25 years) and older (median age: 68 years). Transthoracic echocardiography (TTE) examinations were performed during fasting as well as 30 min after a standardized meal. Measurements of the TTE images were performed off-line for the calculation of VFT. Results: There were no differences in VFT between men and women regardless of age. There was a significant increase in VFT from a median value of 2.0 (1.5–2.5) to a median value of 2.3 (1.5–2.0) after food intake in the older study group (p < 0.001). This was not observed in the younger study group, which had a median value of VFT of 2.5 (2.1–3.0) before food intake and a median value of VFT of 2.5 (2.2–3.1) after food intake (p = 0.369). Furthermore, VFT was significantly higher in the younger study group, i.e., 2.5 (2.1–3.0), compared to the older study group, i.e., 2.0 (1.5–2.5), before food intake (p = 0.011), but not after food intake, with a median value of VFT in the younger group of 2.5 (2.2–3.1) and the older group of 2.3 (1.5–2.9) (p = 0.172). Conclusions: Our findings suggest that VFT is affected by age, not by sex. Moreover, VFT is affected by food intake only in elderly subjects. Full article
(This article belongs to the Special Issue Recent Developments and Emerging Trends of Echocardiography in Cardiac Disease)
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10 pages, 686 KB  
Article
Utility of Simultaneous Left Atrial Strain–Volume Relationship During Passive Leg Lift to Identify Elevated Left Ventricular Filling Pressure—A Proof-of-Concept Study
by Ashwin Venkateshvaran, Urban Wiklund, Per Lindqvist and Thomas Lindow
J. Clin. Med. 2024, 13(24), 7629; https://doi.org/10.3390/jcm13247629 - 14 Dec 2024
Cited by 1 | Viewed by 1474
Abstract
Background: The assessment of left ventricular (LV) filling pressure in heart failure (HF) poses a diagnostic challenge, as HF patients may have normal LV filling pressures at rest but often display elevated LV filling pressures during exercise. Rapid preload increase during passive [...] Read more.
Background: The assessment of left ventricular (LV) filling pressure in heart failure (HF) poses a diagnostic challenge, as HF patients may have normal LV filling pressures at rest but often display elevated LV filling pressures during exercise. Rapid preload increase during passive leg lift (PLL) may unmask HF in such challenging scenarios. We explored the dynamic interplay between simultaneous left atrial (LA) function and volume using LA strain/volume loops during rest and PLL and compared its diagnostic performance with conventional echocardiographic surrogates to detect elevated LV filling pressure. Methods: We retrospectively reviewed 35 patients with clinical HF who underwent simultaneous echocardiography and right heart catheterization before and immediately after PLL. Patients with atrial fibrillation (n = 4) were excluded. Twenty age-matched, healthy controls were added as controls. LA reservoir strain (LASr) was analyzed using speckle-tracking echocardiography. LA strain–volume loops were generated, including the best-fit linear regression line employing simultaneous LASr and LA volume. Results: LA strain–volume slope was lower for HF patients when compared with controls (0.71 vs. 1.22%/mL, p < 0.001). During PLL, the LA strain–volume slope displayed a moderately strong negative correlation with invasive pulmonary arterial wedge pressure (PAWP) (r = −0.71, p < 0.001). At a 0.74%/mL cut-off, the LA strain–volume slope displayed 88% sensitivity and 86% specificity to identify elevated PAWP (AUC 0.89 [0.76–1.00]). In comparison, LASr demonstrated strong but numerically lower diagnostic performance (AUC 0.82 [0.67–0.98]), and mitral E/e’ showed poor performance (AUC 0.57 [0.32–0.82]). Conclusions: In this proof-of-concept study, LA strain–volume characteristics provide incremental diagnostic value over conventional echocardiographic measures in the identification of elevated LV filling pressure. Full article
(This article belongs to the Special Issue Recent Developments and Emerging Trends of Echocardiography in Cardiac Disease)
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Review

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14 pages, 1245 KB  
Review
Carcinoid Heart Disease: The Role of Echocardiography in Raising the First Suspicion
by Silvia Stavagna, Giovanna Manzi, Danilo Angotti, Andrea D’Amato, Elisa Giannetta, Roberto Badagliacca, Federico Ciccarelli, Lucrezia Netti, Paolo Severino, Wael Saade, Carmine Dario Vizza and Viviana Maestrini
J. Clin. Med. 2026, 15(5), 1978; https://doi.org/10.3390/jcm15051978 - 5 Mar 2026
Viewed by 313
Abstract
Neuroendocrine tumors (NETs) are rare neoplasms arising from the diffuse neuroendocrine system that can range from indolent to highly aggressive diseases. They usually clinically manifest when reaching a significant size or when hepatic metastases develop, leading to overproduction and impaired hepatic metabolism of [...] Read more.
Neuroendocrine tumors (NETs) are rare neoplasms arising from the diffuse neuroendocrine system that can range from indolent to highly aggressive diseases. They usually clinically manifest when reaching a significant size or when hepatic metastases develop, leading to overproduction and impaired hepatic metabolism of vasoactive substances. The clinical course of NETs may be complicated by cardiac involvement, known as carcinoid heart disease (CHD), predominantly affecting the right side of the heart. CHD is characterized by specific echocardiographic features, including thickening, reduced excursion and retraction of valvular leaflets, resulting in valvular stenosis or regurgitation. Despite its clinical relevance, awareness of CHD as a complex hormonal sequela of NETs remains limited among cardiologists, and its echocardiographic findings are not universally recognized. This review aims to (a) provide cardiologists with the main principles for understanding CHD pathophysiology; (b) illustrate the main echocardiographic features of CHD, using a stepwise approach; and (c) refine a diagnostic algorithm for detecting cardiac involvement in NET populations and identifying patients at high risk of developing CHD. Full article
(This article belongs to the Special Issue Recent Developments and Emerging Trends of Echocardiography in Cardiac Disease)
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