Background/Objectives: The role of speckle-tracking echocardiography in the diagnosis of stable coronary artery disease (CAD) remains controversial. The aim of this study was to assess the diagnostic accuracy of global longitudinal strain (GLS) in predicting significant CAD. Methods: In this prospective study, 103 symptomatic patients referred for invasive coronary angiography were enrolled. All patients underwent resting echocardiography with GLS assessment prior to angiography. Exclusion criteria included acute coronary syndrome, known history of CAD, and the presence of left ventricular wall motion abnormalities. Significant CAD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Results: The mean patient age was 63.8 ± 9.3 years, with 78.6% being male. Hypertension was present in 63.1% of patients, dyslipidemia in 77.7%, diabetes mellitus in 22.3%, smoking history in 71.9%, and a family history of premature CAD in 24.3%. Significant CAD was identified in 45.6% (n = 47), while the remaining 54.3% (n = 56) had non-significant or no coronary artery disease. Patients with significant CAD exhibited significantly lower GLS values compared to those without (−15.73 ± 2.64% vs. −17.6 ± 1.85%, p = 0.001). A GLS threshold of >−16.3 predicted significant CAD with 66% sensitivity and 73.2% specificity (AUC = 0.692, p = 0.001). GLS demonstrated diagnostic accuracy in identifying disease in individual coronary territories, with AUCs of 0.754 for the left anterior descending artery (LAD), 0.714 for the left circumflex artery (LCx), and 0.723 for the right coronary artery (RCA). Diagnostic performance improved when GLS was combined across all three territories (AUC = 0.796). Conclusions: Resting myocardial GLS is accurate in detecting ischemic myocardial dysfunction and can accurately predict significant stenosis of the respective coronary branch subtending the segments.

Despite significant advancements in medical therapy, heart failure with reduced ejection fraction (HFrEF) continues to be a significant cause of death and disability. Reversible ischaemic left ventricular dysfunction due to viable myocardium is one such contributing factor. In these cases, coronary revascularization has shown promise in improving left ventricular function and prognosis. For patients with HFrEF and wide QRS, cardiac resynchronization therapy (CRT) is an effective option to address electromechanical dyssynchrony. However, approximately 30% of patients do not respond positively to CRT, highlighting the need to refine candidate selection for this treatment. In some patients with reduced HFrEF, there is a condition known as classical low-flow, low-gradient aortic stenosis (AS) that may be observed. This condition is characterized by a low transaortic flow, which leads to reductions in both the transaortic mean gradient and aortic valve area. Decision-making regarding revascularization, CRT, and pharmacological treatment play a crucial role in managing HFrEF. Cardiac imaging can be valuable in guiding decision-making processes and assessing the prognosis of patients with HFrEF. Among the imaging modalities, dobutamine stress echocardiography has come a long way in establishing itself as a feasible, safe, effective, relatively cheap non-invasive technique. The aim of this review is to explore the current literature on the utility of low-dose stress echocardiography in diagnosing and prognosticating patients with HFrEF.

Pulmonary hypertension (PH) is a complex condition in which early diagnosis remains challenging, particularly in patients with exertional symptoms and normal or borderline resting haemodynamics. Although right heart catheterisation is the diagnostic gold standard, transthoracic echocardiography is the recommended first-line non-invasive test. However, resting echocardiography provides only a static assessment and may underestimate disease severity in early or latent pulmonary vascular disease due to preserved pulmonary vascular compliance and adaptive right ventricular responses. Because pulmonary haemodynamics are intrinsically flow-dependent, pathological abnormalities may only emerge during increased cardiac output. Stress echocardiography, performed using exercise or pharmacological stress, enables dynamic evaluation of pulmonary pressure responses, cardiac output augmentation, right ventricular contractile reserve, and ventricular interaction. Increasing evidence indicates that stress echocardiography can unmask abnormal pulmonary pressure–flow relationships, impaired pulmonary vascular reserve, and reduced right ventricular–pulmonary arterial coupling that are not apparent at rest, thereby improving functional and haemodynamic characterisation in selected patients. This Diagnostic Review outlines the physiological basis for stress echocardiographic assessment of pulmonary circulation, proposes practical recommendations for patient selection and testing protocols, and provides a framework for interpretation centered on pressure–flow relationships rather than absolute pulmonary pressure thresholds. Particular attention is given to clinical scenarios with high diagnostic yield, including unexplained exertional dyspnoea, systemic sclerosis, suspected heart failure with preserved ejection fraction, at-risk relatives of patients with pulmonary arterial hypertension, selected athletes, and paediatric populations. Stress echocardiography should not be considered a standalone diagnostic test for PH but, when performed in experienced centers and integrated within structured diagnostic pathways, it represents a valuable non-invasive adjunct to guide referral for invasive haemodynamic confirmation.