Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by unexplained myocardial hypertrophy.Although the diagnosis of HCM is traditionally based on increased left ventricular (LV) wall thickness, contemporary management requires a comprehensive multimodality imaging approach to accurately define disease phenotype, assess functional consequences, and guide risk stratification. Transthoracic echocardiography remains the first-line imaging modality, providing real-time evaluation of LV morphology, systolic and diastolic function, and LV outflow tract obstruction (LVOTO). However, its ability to assess myocardial tissue characteristics and complex morphologic variants may be limited in selected patients. Cardiac magnetic resonance (CMR) offers superior spatial resolution and allows detection of myocardial fibrosis using late gadolinium enhancement. Cardiac computed tomography serves as a complementary tool for evaluating coronary artery anatomy and detailed cardiac structure, particularly in patients with suboptimal echocardiographic windows or contraindications to CMR. This review summarizes the strengths and limitations of each imaging modality and highlights their complementary roles in the evaluation of cardiac morphology, systolic and diastolic function, LVOTO, and tissue characterization. An integrated imaging strat‑ egy is essential for optimized diagnosis, individualized risk stratification, and informed therapeutic decision-making in patients with HCM.

Background: Left bundle branch block (LBBB) significantly increases the risk of left ventricular systolic dysfunction (LVSD) due to cardiac dyssynchrony. Although artificial intelligence–enabled electrocardiography (AI-ECG) mod‑ els show promise in detecting LVSD, their performance in LBBB patients remains underexplored. We hypothesized that an AI-ECG model clinically validated for detecting LVSD would accurately detect LVSD and predict future clinical outcomes in LBBB patients. Methods: In this retrospective multicenter study, 5,689 expert-validated LBBB ECGs collected from 2,813 patients between 2016 and 2024 were analyzed using a previously developed and validated AI-ECG model. LVSD was defined as an ejection fraction of ≤ 40%. Model performance was assessed using the area under the receiver operating char‑ acteristic curve (AUROC), the area under the precision-recall curve (AUPRC), sensitivity, and specificity. Patients were stratified into high- and low-risk groups based on a threshold that achieved 90% sensitivity. A Kaplan–Meier analysis was used to compare clinical outcomes. Results: Among the 2,813 LBBB patients (mean age, 70.7 years; male sex, 43.7%), hypertension and a history of heart failure were common. The AiTiALVSD model showed strong diagnostic performance for LVSD (AUROC, 0.930 [95% CI, 0.924–0.937]; AUPRC, 0.913 [95% CI, 0.902–0.923]; sensitivity, 0.979; specificity, 0.473). During the mean follow-up of 4.1 years, high-risk patients had significantly higher hazards than low-risk patients for all-cause mortality (adjusted hazard ratio [HR], 1.87; 95% CI, 1.53–2.28), implantable cardioverter defibrillator/cardiac resynchronization therapy implantation (adjusted HR, 15.2; 95% CI, 7.51–30.77), and cardiovascular hospitalization (adjusted HR, 1.11; 95% CI, 0.96–1.28). Conclusions AiTiALVSD effectively detects LVSD and stratifies long-term cardiovascular risk in LBBB patients, support‑ ing its clinical utility for early detection and patient management.

Background: Global longitudinal strain (GLS) is a valuable tool for assessing left ventricular (LV) systolic function, detecting subclinical dysfunction earlier than classic ejection fraction. Two-dimensional speckle-tracking echocar‑ diography (2D-STE) is widely used due to its accessibility and high temporal resolution, whereas feature-tracking cardiac magnetic resonance (FT-CMR) offers superior spatial resolution and reproducibility. In this study, we assess the relationships between longitudinal strain measurements obtained by 2D-STE and FT-CMR in patients with chronic ischemic heart disease (IHD). Methods: Fifty-five patients with IHD and left ventricular ejection fraction (LVEF) ≤ 49% underwent 2D-STE and FTCMR at least 3 months after an acute coronary event. Global and segmental longitudinal strain for all 17 myocardial segments was measured using both modalities. Pearson correlation and Bland–Altman analysis were used to assess correlation and agreement, respectively. Results: GLS showed a strong correlation between 2D-STE and FT-CMR (r = 0.793, P < 0.001), with a mean difference of 0.98% and limits of agreement from –3.2% to + 5.1%. Segmental strain demonstrated greater variability (r = 0.03 to 0.47), with the best agreement in mid and apical segments and greatest discrepancies at the basal level. Conclusions In patients with IHD and reduced LVEF, GLS obtained by FT-CMR and 2D-STE showed strong correla‑ tion and acceptable overall agreement. However, the relatively wide limits of agreement and variability in segmental strain, particularly in basal regions, indicate that the two methods are not fully interchangeable for individual assess‑ ment and follow-up. Both techniques reflect similar physiological trends but differ in absolute values, requiring cau‑ tion in regional strain interpretation.

Background: Transthoracic echocardiography (TTE) requires time-intensive integration of quantitative measure‑ ments and qualitative visual assessment. Fully automated artificial intelligence (AI)-based analysis may reduce total analysis time while preserving accuracy, but systematic real-world validation remains limited. Methods: This prospective, single-center pilot study enrolled 40 TTE examinations. Identical deidentified DICOM datasets were independently provided to a trained cardiac sonographer and a fully automated AI system comprising quantitative and qualitative visual interpretation modules. All outputs were compared with a cardiologist-adjudicated reference standard. Primary endpoints were total analysis time and noninferiority of AI-derived left ventricular ejection fraction (LVEF) versus the reference standard, with a prespecified margin of 3 percentage points (one-sided α = 0.025). Results: Median analysis time was 94 s (interquartile range [IQR], 82–106 s) for the AI workflow versus 490 s (IQR, 438–626 s) for the human workflow (P < 0.001). AI-derived LVEF met the noninferiority criterion (mean difference, 0.00 percentage points; upper one-sided 95% confidence bound, 1.41 percentage points; P < 0.001), with an intraclass correlation coefficient (ICC) of 0.902 (95% confidence interval, 0.822–0.947). ICCs for secondary quantitative indi‑ ces ranged from 0.625 to 0.989. For aortic regurgitation severity grading, AI’s overall accuracy was 75.0% (quadratic weighted κ = 0.762), compared with 82.5% for human interpretation (κ = 0.812, McNemar P = 0.579). Conclusions Fully automated AI-assisted TTE analysis substantially reduced total analysis time while maintaining noninferior LVEF accuracy and acceptable performance across secondary quantitative and qualitative indices. These findings support the use of AI as a practical workflow accelerator in routine echocardiography.

Background: Anthracycline-based chemotherapy is highly effective in breast cancer treatment but is limited by dose-dependent cardiotoxicity. Early identification of subclinical myocardial injury is crucial to prevent progression to irreversible dysfunction. Objectives: To evaluate whether a multimodal surveillance strategy integrating left ventricular global longitudinal strain (LVGLS), left atrial reservoir strain (LASr), and high-sensitivity troponin I (hs-TnI) can predict early anthracyclineinduced cardiotoxicity. Methods: This retrospective cohort study included 50 female breast cancer patients (mean age 49.3 ± 8.5 years) treated between January 2022 and December 2024. Echocardiography and biomarkers were assessed at baseline and 1 month after chemotherapy. Cardiotoxicity was defined as a > 10% reduction in LVEF to < 53%. Results: Cardiotoxicity occurred in 15 patients (30%). LVGLS, LASr, and hs-TnI significantly changed (all P < 0.001).Independent predictors were LVGLS (aOR 1.33), LASr (aOR 0.77), and hs-TnI (aOR 1.07). hs-TnI showed the highest discriminative ability (AUC 0.940). Conclusions LVGLS, LASr, and hs-TnI provide complementary information for early detection of cardiotoxicity.

Background: Small studies suggest that variations in plasma potassium (p-K) levels may affect cardiac contractile function. A substudy to the recently published POTCAST trial demonstrated short-term improvements in myocardial function in patients randomized to potassium-increasing treatment. However, the long-term effects of increasing p-K on cardiac function remain unclear. This study aimed to investigate whether treatment that increases p-K improves diastolic and systolic myocardial function as assessed by echocardiography during long-term follow-up in a Danish implantable cardioverter-defibrillator (ICD) cohort. Methods: The POTCAST trial randomized patients with an ICD (1:1) to either usual therapy (control group) or treatment with oral potassium supplements and/or mineralocorticoid receptor antagonists (high-normal potassium group). In this substudy, consecutive patients from both arms of the POTCAST trial were included. Echocardiography was performed at baseline and repeated after > 6 months for the current study to compare changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global constructive work (GCW), and diastolic parameters (E, e’, and E/e’) between the high-normal potassium and control groups. Results: A total of 289 patients (mean age, 58 ± 13.4 years; 77.5% male) were included in the study. The median follow-up time between baseline and follow-up echocardiography was 729 days (interquartile range, 511–986 days).From baseline to follow-up the high-normal potassium group had an increase in mean difference in p-K of 0.22 mmol/L (95% confidence interval [CI], –0.31 to –0.13; P < 0.001) compared to the control group. In the high-normal potassium group e’lat increased by 0.77 cm/sec (95% CI, 0.12–1.40; P = 0.020), and E/e’lat decreased by –1.15 (95% CI, –2.1 to –0.25; P = 0.013) on average compared to the control group. No significant differences were observed in changes in other diastolic parameters. For systolic function, no significant differences were found between groups in terms of change in LVEF (–0.6%; 95% CI, –2.17 to 1.02; P = 0.475), GLS (–0.26%; 95% CI, –0.8 to 0.4; P = 0.472), or GCW (–3.99 mmHg; 95% CI, –89.5 to 81.6; P = 0.927). Conclusions In contrast to previous short-term findings, when myocardial function was assessed by echocardiography, long-term potassium-increasing treatment led to only minor improvements in diastolic function in a contemporary Danish ICD cohort.

Background: Anthracycline-based chemotherapy agents are widely used and are highly effective, particularly for breast cancer treatment. Although the cardiotoxic effects of anthracyclines on left ventricular (LV) function are well established, their impact on right ventricular (RV) function has not been sufficiently investigated. This study aimed to evaluate the effects of anthracycline therapy on RV function and to compare them with LV function to determine the potential cardiotoxic effects on both ventricles. Methods: This single-center retrospective cohort study included 38 female patients with breast cancer who were treated with anthracyclines between January 2021 and June 2023. Echocardiographic parameters and cardiac biomarkers were evaluated at baseline and at 6-month follow-up visit. LV ejection fraction (LVEF) was calculated using the Teichholz method due to the retrospective design. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio. Cancer therapy–related cardiac dysfunction (CTRCD) was defined according to current European Society of Cardiology criteria. Serum troponin I and pro–brain natriuretic peptide levels were recorded. Paired comparisons were performed using the paired-samples t-test. Results: Following anthracycline therapy, LV end-systolic diameter increased (2.76 ± 0.24 cm vs. 3.03 ± 0.29 cm, P < 0.001), and LVEF decreased (67.3% ± 3.6% vs. 62.2% ± 4.5%, P < 0.001). No patient fulfilled the guideline-defined criteria for CTRCD. Early diastolic transmitral flow velocity (E wave) and mitral annular early diastolic velocity (e′) were reduced (E: 0.63 ± 0.16 m/sec vs. 0.52 ± 0.12 m/sec, P < 0.001; e′: 0.09 ± 0.03 m/sec vs. 0.07 ± 0.02 m/sec, P = 0.001).TAPSE decreased (2.28 ± 0.36 cm vs. 2.16 ± 0.27 cm, P = 0.047), and systolic pulmonary artery pressure showed a nonsignificant upward trend after treatment (P = 0.052). The TAPSE/sPAP ratio declined (1.11 ± 0.47 vs. 0.86 ± 0.20, P < 0.001), and pulmonary artery diameter increased (19.9 ± 2.0 mm vs. 21.3 ± 2.6 mm, P = 0.008). Serum troponin I levels increased significantly (4.84 ± 1.25 ng/L vs. 11.93 ± 4.91 ng/L, P < 0.001). Conclusions Anthracycline therapy may be associated with modest changes in both LV and RV parameters. Reductions in TAPSE and the TAPSE/sPAP ratio, together with a nonsignificant upward trend in systolic pulmonary artery pressure, may reflect subtle alterations in RV–pulmonary arterial interactions rather than overt RV dysfunction. Routine evaluation of RV function, alongside LV assessment, may provide additional insights during cardiotoxicity monitoring in anthracycline-treated patients. These findings should be interpreted cautiously and confirmed in larger prospective studies.

Background: We aim to analyze the additive value of repeated transthoracic echocardiography (TTE) within a 1-week interval after a baseline TTE to diagnose infective endocarditis (IE) in patients admitted with Staphylococcus aureus bacteremia (SAB). Methods: We prospectively enrolled consecutive patients with SAB who were referred for TTE and transesophageal echocardiography (TEE) to exclude IE between January 2017 to December 2019. All patients underwent a second TTE within 5 to 7 days. We excluded patients with poor echo windows, previous IE, valve repair/replacement, and those with cardiac devices or a dialysis catheter in place. Results: A total of 105 patients were enrolled, of which 40 (38.1%) were female. The mean age was 52 ± 14 years.Sixty-four patients (61%) had a defined source of infection, and 36 (34.3%) were intravenous drug users. The majority (n = 74, 70.5%), had methicillin-sensitive S. aureus. Sixteen patients (15.2%) were diagnosed with definite IE based on TEE findings as follows: eight tricuspid valve IE, four mitral valve IE, three aortic valve IE, and one with double valve IE (mitral and tricuspid). The mortality rate was 7.6% (two patients with definite IE and six without IE). Vegetations were not detected in one patient on the first TTE, compared to TEE and the second TTE. The baseline TTE had a sensitivity of 93.8%, specificity of 87.6% and accuracy of 88.6% in identifying echocardiographic evidence of IE. The addition of second TTE findings increased the sensitivity to 100%, specificity to 95.5%, and diagnostic accuracy to 96.2% in comparison to TEE for the detection of IE. Conclusions A repeat TTE within 5 to 7 days of an initial study significantly enhances diagnostic accuracy for detecting IE in patients with SAB and may help reduce the need for TEE in selected low-risk cases.

Background: Transthoracic echocardiography derived left ventricular ejection fraction (LVEF) is a cornerstone in heart failure risk prevention. However, the lower limits of normal LVEF remains imprecisely defined. We aimed to define normal LVEF ranges by sex, age group, and self-reported race/ethnicity using data from population-based echocardiographic studies. Methods: We systematically searched MEDLINE for studies published between January 1, 2000, and January 3, 2025, that reported the mean and standard deviation of LVEF measured by 2D or 3D echocardiography in healthy, community-based adult populations. Results: In 10 studies (n = 10,427; female sex, 48%), the pooled mean LVEF was 62.8% (95% confidence interval, 61.0%–64.7%), with estimated lower and upper normal limits of 51.8% and 73.2%, respectively. Women had higher mean LVEF (63.7%) than men (61.9%), with corresponding lower normal limits of 52.7% and 51.7%, respectively. LVEF was similar across age groups. Individuals of Asian origin had 2 to 3 percentage points higher LVEF than Black or White individuals, with lower normal limits of 54% for women and 53% for men. Fewer than 1% of women and approximately 1% of men would be expected to have an LVEF below 50%. Across all demographic subgroups, the probability that an LVEF < 50% is within the normal range was < 5%. There was significant heterogeneity of the included studies (e.g., τ2 = 8.82, ­I2 = 99.7% for overall analysis) that appeared unexplained by sex, age, or echocardiography modality (2D vs. 3D). Conclusions In healthy adults, the lower limit of normal LVEF is approximately 53% for women and 52% for men, with slightly higher thresholds among individuals of Asian origin. An LVEF < 50% is highly unlikely to reflect normal function, regardless of sex, age, or self-reported race/ethnicity. Given the high statistical heterogeneity, the results should be interpreted with caution.