Jan Knierim

Zusammenfassung: Die Echokardiografie ist die am häufigsten eingesetzte bildgebende Methode zur Beurteilung des Herzens. Sie spielt in der kardiologischen Routine, in Akut- und Notfallsituationen eine zentrale Rolle und ist ein unverzichtbarer Bestandteil der medizinischen Entscheidungsfindung. Trotz ihrer hohen klinischen Relevanz fehlten bislang nationale Empfehlungen, die Untersuchungsablauf, Geräte-Einstellung und Bilddokumentation einheitlich regeln. Die vorliegende Leitlinie wurde von der Deutschen Gesellschaft für Ultraschall in der Medizin (DEGUM) und der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK) unter Beteiligung der Deutschen Gesellschaft für Innere Medizin (DGIM), der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), des Berufsverbandes Deutscher Internistinnen und Internisten (BDI) und des Bundesverbandes Niedergelassener Kardiologen (BNK) erarbeitet. Im strukturierten Konsensus-Verfahren wurden die Empfehlungen abgestimmt, als Konsultationsfassung veröffentlicht und nach Auswertung der Rückmeldungen final durch die beteiligten Fachgesellschaften verabschiedet. Das Dokument erfüllt die Kriterien einer S2k-Leitlinie der AWMF und definiert verbindliche Standards für die Durchführung der transthorakalen Echokardiografie. Es legt fest, welche Aufnahmen und Messungen erforderlich sind, um valide und reproduzierbare Befunde zu gewährleisten. Zentrale Empfehlungen betreffen die Geräte-Einstellung, die Bildakquisition, den minimal zu erfassenden Datenumfang sowie die Abgrenzung zur fokussierten kardialen Ultraschall-Untersuchung (FoCUS). Die vollständige Langversion ist auf der Website der AWMF verfügbar.

Echocardiography is the most commonly used imaging method for evaluating the heart. It plays a central role in the cardiology routine and in acute and emergency situations, and is an essential component of the medical decision-making process. In spite of its high clinical relevance, national recommendations standardizing the examination procedure, equipment settings, and image documentation have been lacking. The present guidelines were created by the German Society for Ultrasound in Medicine and the German Cardiac Society in coordination with the German Society of Anesthesiology and Intensive Care Medicine, German Society of Internal Medicine, Professional Association of German Internists, and the German Association of Cardiologists in Private Practice. The recommendations were formulated in consensus, published as draft guidelines, and finalized by the participating professional associations after evaluation of the feedback. The document meets the criteria for S2k guidelines in accordance with the Association of Scientific Medical Societies in Germany and defines binding standards for performing transthoracic echocardiography. The guidelines define which images and measurements are required to ensure valid and reproducible findings. The main recommendations relate to device settings, image acquisition, the minimum dataset to be acquired, and the definition of focused cardiac ultrasound (FoCUS). The complete long version of the guidelines is available on the website of the Association of Scientific Medical Societies in Germany. Note The short version of this guideline is being published simultaneously in the journals Ultraschall in der Medizin – European Journal of Ultrasound and Die Kardiologie.

10.1055/a-2775-3065 Article published online: 19 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Durable left ventricular assist devices (LVADs) are an established and highly effective therapy for patients with advanced heart failure. Ongoing technological improvements and structured follow-up programs have significantly enhanced device durability, reduced complications, and improved long-term survival. Consequently, a growing number of patients with LVAD support require long-term outpatient care and increasingly present to both specialized and non-specialized hospitals, including for admissions unrelated to heart failure. In this context, echocardiography plays a central role. It is essential not only for routine follow-up at dedicated LVAD clinics but also for the assessment of cardiac status during inpatient admissions for extracardiac conditions. However, echocardiographic evaluation in LVAD patients is technically demanding and requires a solid understanding of LVAD physiology, device–heart interactions, and the specific hemodynamic conditions of continuous-flow support. Without this knowledge, standard echocardiographic parameters may be misleading. This review provides sonographers and cardiologists with a practical, clinically oriented framework for routine transthoracic echocardiography in patients with durable LVAD support. We summarize key principles of LVAD hemodynamics, discuss interpretation of LVAD console parameters, propose a standardized imaging protocol, and outline a structured approach to common echocardiographic findings in routine ambulatory and inpatient settings.

Durable left ventricular assist devices (LVADs) are an established and highly effective therapy for patients with advanced heart failure. Ongoing technological improvements and structured follow-up programs have significantly enhanced device durability, reduced complications, and improved long-term survival. Consequently, a growing number of pa-tients with LVAD support require long-term outpatient care and increasingly present to both specialized and non-specialized hospitals, including for admissions unrelated to he-art failure. In this context, echocardiography plays a central role. It is essential not only for routine follow-up in dedicated LVAD clinics but also for the assessment of cardiac status during inpatient admissions for extracardiac conditions. However, echocardiographic evaluation in LVAD patients is technically demanding and requires a solid understanding of LVAD physiology, device–heart interactions, and the specific hemodynamic conditions of conti-nuous-flow support. Without this knowledge, standard echocardiographic parameters may be misleading. This review provides sonographers and cardiologists with a practical, clinically oriented framework for routine transthoracic echocardiography in patients with durable LVAD support. We summarize key principles of LVAD hemodynamics, discuss interpretation of LVAD console parameters, propose a standardized imaging protocol, and outline a struc-tured approach to common echocardiographic findings in routine ambulatory and inpa-tient settings.

Echocardiography is the most commonly used imaging modality in cardiology and serves as a crucial first step in diagnosis and therapeutic decision making. This expert proposal aims to address methodological requirements in order to make the correct diagnosis and prevent diagnoses from being overlooked due to improper use. Graphical Abstract

Background: Aortic regurgitation (AR) is a well‐known cause of impaired outcome in patients with centrifugal left ventricular assist devices (cfLVADs). The failure of the aortic valve (AV) to open at least intermittently is associated with cusp remodeling, commissural fusion, and ultimately developing AR.Our aim was to characterize patients in whom AV opening (AVO) was preserved 6 months after implantation and identify determinants related to it.Methods and Results: We conducted standardized echocardiography and collected clinical and laboratory tests at the outpatient clinic 6 months after implantation. We classified patients into those showing intermittently opening of the AV, every 2–3 beats, or in every cycle (AVO) and those whose AV was continuously closed (NAVO). From the 219 cfLVAD implanted in our center between March 2018 and January 2020, 156 subjects were alive and on the device after 6 months. In 2 of the reviewed echocardiograms, we could not evaluate the AV. 99 patients (64%) showed AVO compared to 55 (36%) with NAVO. The first presented higher mean arterial pressure (84 ± 10 vs. 77 ± 13 mm Hg, p = 0.002), larger LV end‐diastolic diameter (LVEDD 57.5 ± 12 vs. 52.7 ± 13 mm, p = 0.022), a better TAPSE (15 ± 4 vs. 13 ± 4 mm, p = 0.028), and less frequently significant AR than patients with NAVO (moderate/severe AR in 6% vs. in 20%, p = 0.042). In a multiple logistic regression, a lower NYHA Class, a larger LVEDD, and a better LV ejection fraction appeared as significant predictors of AVO. After a median follow‐up of 3.2 years, we found no significant impact on survival stratifying patients by AVO (log‐rank p = 0.53).Conclusion: AVO was associated with better RV function, lower NYHA Class, and a lower rate of significant AR. This could indicate that AVO should be pursued in LVAD patients.

The left atrial appendage is a blind ending cardiac structure prone to blood stasis due to its morphology. This structure is a preferred region of thrombogenesis in relation to reduced myocardial contractility of the atrial wall. Blood stasis occurs primarily in low flow conditions. One of the tasks of echocardiography is the analysis of morphology and function of the left atrial appendage. The detection of thrombi by echocardiography is difficult and must be carried out thoroughly and carefully to avoid potential complications—especially in the context of rhythm control. The assessment of thromboembolic risk, especially in patients with unknown and presumed atrial fibrillation is a second challenge by characterizing atrial function and flow conditions in the left atrial appendage. Thus, this proposal focuses on the obvious problems of echocardiography when assessing left atrial appendage and the role of this method in planning a potential interventional closure of left atrial appendage.

Echocardiography in patients with atrial fibrillation is challenging due to the varying heart rate. Thus, the topic of this expert proposal focuses on an obvious gap in the current recommendations about diagnosis and treatment of atrial fibrillation (AF)—the peculiarities and difficulties of echocardiographic imaging. The assessment of systolic and diastolic function—especially in combination with valvular heart diseases—by echocardiography can basically be done by averaging the results of echocardiographic measurements of the respective parameters or by the index beat approach, which uses a representative cardiac cycle for measurement. Therefore, a distinction must be made between the functionally relevant status, which is characterized by the averaging method, and the best possible hemodynamic status, which is achieved with the most optimal left ventricular (LV) filling according to the index beat method with longer previous RR intervals. This proposal focuses on left atrial and left ventricular function and deliberately excludes problems of echocardiography when assessing left atrial appendage in terms of its complexity. Echocardiography of the left atrial appendage is therefore reserved for its own expert proposal.

Speckle-tracking echocardiography (STE) parameters are an integral part of the assessment of left ventricular (LV) function. We aimed to evaluate established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm undergoing surgical ventricular repair (SVR). We retrospectively examined the data of 137 patients with anteroapical LV aneurysm who underwent SVR. In 27 patients, the correlation of STE parameters with invasive hemodynamic parameters was evaluated. Preoperative echocardiographic parameters were assessed for their association with outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. The late diastolic strain rate (GLSRa) showed a stronger correlation with mean pulmonary artery pressure (r = − 0.75, p < 0.001) than all other parameters. GLSRa was also significantly correlated with mean pulmonary capillary wedge pressure and LV end-diastolic pressure. In the multivariate model, GLSRa and the ratio of early diastolic filling velocity to GLSRa demonstrated incremental prognostic value in addition to clinical and echocardiographic parameters. Patients with GLSRa < 0.59 s⁻¹ had significantly shorter event-free survival than those with GLSRa > 0.59 s⁻¹ (6.7 vs. 10.9 years, p < 0.001). Peak reservoir left atrial strain showed a weaker association with hemodynamic parameters and outcome compared to GLSRa. In patients with LV aneurysm, late diastolic strain rate and left atrial strain can be used for the assessment of LV diastolic function and have a predictive value for the outcome after surgical ventricular restoration. Graphical