Dear Editor, COVID-19 infection has been recognized as a global public health concern owing to associated morbidities, involvement of different systems, and high case fatality rates.[1] The findings of a large-scale cohort study done in the United States reported significantly higher risk of dysrhythmias, ischemic and nonischemic heart disease, pericarditis, myocarditis, heart failure, etc., among both hospitalized and nonhospitalized COVID-19 survivors.[2] Considering the high prevalence of subclinical cardiac injuries, the emergence of symptoms weeks or months after recovery, and the high risk of fatal outcomes, there is an indispensable need for routine cardiovascular screening, especially among high-risk groups of people.[3] Moreover, early detection of cardiac dysfunction enables the timely initiation of cardioprotective therapies, including lifestyle modifications to prevent disease progression.[2,3] Echocardiography has been recommended for the post-COVID-19 cardiac assessment because it is a noninvasive and radiation-free modality, which is widely available, cost-effective, and enables real-time evaluation of acutely ill or immobile patients.[4] The findings of a study done to assess left ventricular dysfunction in the 3rd year after COVID-19 hospitalization, it was reported that 61% of the study participants had left ventricle systolic subclinical dysfunction.[5] Another study done among the COVID-19 survivors in the United States, echocardiography results revealed that almost 24% of the study participants had right ventricle dilatation or decreased systolic function.[6] Further, the option of tele-echocardiography expands its utility in remote areas, which is vital for clinical decision-making and detection of subclinical abnormalities before the onset of symptoms.[1] Echocardiography can detect multiple post-COVID-19 changes, like left ventricular dysfunction (reduced ejection fraction), right ventricular dysfunction, and myocardial strain even with preserved ejection fraction.[1,4] It can also detect small pericardial effusion, pulmonary hypertension, and diastolic dysfunction.[1,4] Based on the findings obtained from a study which indicated the presence of cardiovascular manifestations (such as decreased left ventricle function, valvulitis, and arrhythmia) in 56%–100% of pediatric patients who developed multisystem inflammatory syndrome after COVID-19 infection, echocardiographic assessment at periodic intervals has been strongly advocated.[7] The results from another review indicated that in the acute phase of COVID-19 infection, average 70% pediatric patients presented with reduced left ventricle ejection fraction and regional wall motion abnormalities.[8] Owing to the potential merits and feasibility, including the option of portable and handheld devices, echocardiography should be integrated into public health surveillance in urban, rural, remote, mobile teams, and community screening programs.[1,2,4] This integration will not only enable early detection of cardiac sequelae in the population but also ensure epidemiological mapping (viz. identification of regional patterns, potential risk factors, prevalence of cardiac complications, etc.), which is crucial for targeted interventions.[3,4,9] Further, the inclusion of echocardiographic indices into health information systems can improve real-time monitoring of post-COVID-19 cardiovascular burden.[9] In contrast to the conventional echocardiography which may miss early subclinical myocardial dysfunction in post-COVID-19 patients, speckle-tracking echocardiography is a more sensitive tool to assess myocardial abnormalities.[10] The need of the hour is to standardize echocardiographic evaluation as a part of long COVID-19 care, as it will strengthen functional cardiac recovery.[4] This proposed integration will facilitate the attainment of set goals for noncommunicable diseases, will raise awareness among the general population about post-COVID-19 heart health, and empower communities to seek timely medical assistance.[9,11] Acknowledging the utility and scope of echocardiography in post-COVID-19 cardiac assessment, there is an immense need to establish protocols for post-COVID-19 cardiac screening for periodic detection of subclinical cardiac dysfunction using echocardiography.[4,9] However, for its execution on a large scale, we must invest in portable and handheld echocardiography devices, train health workers in basic echocardiography interpretation, and explore the possibility of telemedicine platforms to connect rural centres with specialists for real-time interpretation.[1,2] These capacity-building activities must be supported with the inclusion of cardiac surveillance in electronic health records and surveillance dashboards, and also linked with existing national programs to ensure continuity of care.[2,11] To begin with, we focus on high-risk and vulnerable people (like the elderly, coexisting morbidities, underserved population groups, etc.) and then expand to community-based screening.[3] The prioritization among high-risk individuals can be done on the basis of criteria, like adults aged 65 years or with < 1 cardiovascular risk factor (e.g., hypertension, diabetes, obesity, preexisting heart disease), and patients who experienced moderate-severe form of COVID-19 requiring admission or elevated cardiac biomarkers.[12,13] In conclusion, the integration of echocardiography into public health surveillance is a cost-effective and impactful diagnostic approach to minimize the incidence of long-term COVID-19 cardiac sequels and strengthen health system resilience. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Atrial fibrillation can arise from a range of underlying mechanisms, including electrical triggers, structural remodeling, metabolic influences, and inflammatory substrates, each of which requires a tailored therapeutic strategy. Understanding the specific atrial substrate responsible for the arrhythmia is therefore essential to guide appropriate management. In this context, echocardiography serves not only as a diagnostic tool but also as a key decision-making instrument, enabling clinicians to noninvasively evaluate the structural, mechanical, and electrical properties of the left atrium. Parameters such as left atrial strain, conduction time (PA-tissue Doppler imaging), and left atrial volume index provide valuable insights into the extent of atrial remodeling and fibrosis, which directly influence therapeutic choices and expected outcomes. While the diagnostic role of echocardiography in atrial fibrillation is well recognized, its integration into therapeutic decision-making, particularly in guiding rhythm control strategies, remains underutilized. This case series aims to address that gap by illustrating how echocardiographic findings can inform the selection, timing, and modality of interventional versus conservative treatment. We present three patients with distinct clinical backgrounds: one with structurally normal atria, one with atrial remodeling due to epicardial adipose tissue infiltration, and one elderly patient with moderate substrate alteration, where comorbidities and minimal symptom burden led to a conservative management decision. Each case highlights how advanced echocardiographic assessment can support individualized treatment planning, from catheter ablation to optimal medical therapy, in alignment with precision medicine principles.

Mitral regurgitation (MR) is a valvular heart disease with high morbidity and mortality. Transcatheter edge-to-edge repair (TEER) presents a viable treatment option for severe MR in high-risk surgical patients. This review aims to assess the prognostic significance of speckle-tracking echocardiography (STE) in predicting outcomes after TEER and its potential role in patient management. A systematic literature review was done on PubMed for studies until November 2024. The search incorporated keywords of STE and TEER, including original research on STE's predictive value in TEER patients. Studies concerning surgical mitral valve repair or unrelated imaging techniques were excluded. Twenty-nine articles were included, indicating that STE metrics, especially global longitudinal strain (GLS), correlate with clinical outcomes like heart failure progression and mortality. Baseline GLS was determined as predictive of hospitalization and mortality, while post-TEER GLS improvements were associated with better functional capacity. Furthermore, left atrial function metrics were significant in predicting arrhythmia recurrence. This study highlights the utility of STE in predicting outcomes for TEER patients. While findings are encouraging, additional research is essential to elucidate the long-term effects of TEER on cardiac function, thereby enhancing patient selection and management approaches. This review highlights the relevance of STE in prognosticating outcomes for patients undergoing TEER. Further investigations are essential to clarify the long-term repercussions of TEER on cardiac functionality, thereby refining patient selection and management strategies.

Context:Minimally invasive mitral valve repair (MIMVr) has emerged as a promising alternative to conventional surgery procedures for addressing severe degenerative mitral regurgitation (MR). It provides early benefits such as reduced morbidity, shorter hospital stays, quicker recovery, and consistent long-term safety and efficacy. Exercise stress echocardiography (ESE) is essential for evaluating MR and pulmonary pressures during peak exercise, especially in patients with discordant symptoms and regurgitation grades at rest. ESE helps assess dynamic changes in hemodynamics and guide treatment strategies.Aims:This study evaluates the hemodynamic impacts and clinical outcomes of MIMVr using ESE at 2 years posttreatment.Settings and Design:It is a retrospective study of patients who underwent MIMVr between 2020 and 2021 and ESE-evaluated at 2 years posttreatment.Materials and Methods:In this retrospective cohort study, we compared 13 patients with 13 age-matched healthy controls. All patients underwent resting and stress echocardiography using a semi-supine bicycle ergometer, Bruce, and SIECVI protocols for MR stress-echo.Results:Preoperatively, most subjects were NYHA class II/III, with a shift to class I by 2 years postsurgery. ESE showed significant improvements in ejection fraction (61.4%–73.5%, P < 0.001) and decreased LV filling pressure (E/e’ ratio from 14.4 to 10.1, P = 0.01). MIMVr patients showed reduced heart rate, double product during stress, and no stress-induced ischemia or significant arrhythmias.Conclusions:This pilot study suggests that MIMVr provides meaningful 2-year improvements in cardiac function, approaching normal parameters. However, given the small, single-center design, these findings are primarily hypothesis-generating and warrant confirmation in larger prospective trials.

Accurate selection of patients referred for LVADs is essential to prevent peri- and postoperative complicationsEchocardiography is the first line imaging modality for the evaluation of LVAD candidatesStudy of RV geometry and function is mandatory to detect subclinical RV dysfunction which could cause RV failure after-LVAD implantation, a frequent and potentially life-threatening complicationSevere valvular heart disease, ascendant aorta and possible intracardiac thrombi or shunts should be carefully evaluated, since these may represent some limit to LVAD implantation.

Tuberous sclerosis complex has an autosomal dominant pattern of inheritance. Hamartomas are seen in various organs in tuberous sclerosis. Tuberous sclerosis is linked to cardiac rhabdomyomas, which is one of the common heart tumors in children. We present a full-term neonate who was suspected to have the congenital disease due to the presence of pansystolic murmur on examination. Echocardiography revealed multiple rhabdomyomas in the right ventricular (RV) and LV wall and interventricular septum of varying sizes and shapes. The largest rhabdomyoma arising from the lateral wall of RV measuring 16 mm × 18 mm. There was 6 mm × 8 mm rhabdomyoma protruding in the left ventricular outflow tract in nonobstructive manner. There was no inflow or outflow obstruction. Small apical muscular ventricular septal defect noted. Mother had numerous papulonodular lesions on both cheeks, nose, and forehead (adenoma sebaceum). No other neurocutaneous markers were present. Mother had no systemic involvement. In babies born to mothers with suspected tuberous sclerosis, a high degree of suspicion is required to rule out cardiac tumors.

Artificial intelligence (AI) is transforming cardiovascular imaging (CVI), enhancing accuracy, efficiency, and diagnostic capability across echocardiography (Echo), cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR). In Echo, AI improves image acquisition, segmentation, quantification of chamber function, and detection of wall motion abnormalities, supporting diagnosis and prognosis in various diseases. Automated two-dimensional and three-dimensional (3D) analysis allows rapid, reproducible assessments of ventricular volumes and EF. In valvular heart disease, AI assists in measurement, procedural planning, and integration with 3D printing. CCT benefits from AI at every workflow stage, from image acquisition to disease assessment. AI optimizes scanning protocols, reduces radiation exposure, and enhances coronary artery calcium scoring, plaque analysis, and ischemia evaluation. Algorithms enable rapid segmentation and functional assessment, while ongoing studies support its utility in risk prediction and plaque characterization. In CMR, AI accelerates acquisition, reduces artifacts, and automates segmentation and tissue characterization. Deep learning (DL) models accurately detect fibrosis, scar, and functional parameters, positively influencing prognosis prediction in every cardiac disease. AI-driven tools also streamline report generation, enhance Telemedicine workflow, and guide less experienced users in image acquisition. Despite these advances, challenges remain. Robust and diverse datasets, explainable AI models, regulatory approvals, and ethical considerations are critical for safe and widespread adoption. AI’s “black box” nature hinders clinician trust, making interpretability essential. As these barriers are addressed, AI is expected to become an essential tool in every aspect of CVI, enabling personalized medicine, improving patient care, and optimizing clinical workflows in the coming decades.

Infective endocarditis (IE) is a rare disease, but its impact is significant as it affects 3–10/100,000 per year in the population. According to the current guidelines ESC 2023, the evidence of lesions characteristic of IE is a major diagnostic criterion. Echocardiography is the first-line imaging technique to diagnose IE and to assess the structural and functional damage of cardiac structures. Transesophageal echocardiography (TEE) is recommended in patients with an inconclusive or negative TTE, in patients with high suspicion of IE, as well as in patients with a positive TTE, to document local complications. Other imaging modalities, such as cardiac computed tomography and nuclear imaging, are needed to confirm or exclude the diagnosis of IE, to characterize the extent of the cardiac lesions, and to diagnose cardiac complications. The aim of this article was to review the potential role of cardiac imaging, especially of TEE and cardiac CT in evaluating IE perivalvular complications.

Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up. The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded. The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up. This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years.