Background: The integration of global longitudinal strain (GLS) with stress echocardiography (SE) represents a significant advancement in non-invasive cardiac diagnostics, particularly in the evaluation of coronary artery disease (CAD). GLS, derived from speckle-tracking echocardiography, quantifies myocardial deformation and offers superior sensitivity for detecting subclinical myocardial dysfunction compared to conventional metrics like wall motion and ejection fraction. Recent studies have validated the prognostic and diagnostic efficacy of GLS both at rest and during stress, notably enhancing the detection of obstructive and non-obstructive CAD, microvascular dysfunction, and other cardiac pathologies. Methods: This manuscript synthesizes extensive clinical data demonstrating the added value of GLS during stress echocardiography across diverse cardiac conditions—including valvular heart disease, heart failure, cardio-oncology, and pediatric cardiology. Novel metrics like longitudinal strain reserve (LSR), myocardial work indices, and post-systolic strain have further enriched risk stratification strategies. Results: The combination of GLS with SE has been shown to approximate the accuracy of invasive coronary angiography in intermediate-risk patients and in cases with equivocal traditional SE findings. Despite its clinical promise, the utility of GLS is challenged by technical limitations, including image quality dependency, inter-vendor variability, and limited applicability during high heart rate states. Conclusions: As technological refinement and standardization progress, GLS integrated with SE is poised to become a mainstay in precision cardiology, improving diagnostic yield, guiding therapeutic decisions, and enhancing patient outcomes.

Background/Objectives: Telemedicine (TM) has emerged as a promising tool for improving heart failure (HF) management by allowing non-invasive, remote patient monitoring. However, patient adherence to TM plays a critical role in its effectiveness. This systematic review aims to assess adherence levels to non-invasive TM interventions and explore factors influencing compliance. Methods: This systematic review followed the PRISMA guidelines. A literature search was conducted across the PubMed, Medline, Web of Science, and Google Scholar databases to identify prospective randomized controlled trials published between January 2010 and June 2024. The inclusion criteria included studies focused on non-invasive TM in HF patients with a follow-up period longer than three months. Adherence rates were categorized as high (≥80%), moderate (60–79%), or low (<60%). Results: Of the 136 identified studies, 6 met the inclusion criteria. Three studies reported high adherence (>80%), and three moderate adherence (60–79%). Older patients (≥65 years) showed higher adherence, with two studies exceeding 85% adherence. Studies with higher female participation (>30%) reported better adherence, with two exceeding 88%. Across studies, a lack of racial diversity was especially notable, apart from a study that included a population with 69% black and 31% Hispanic participants, where adherence was 50% for ≥10 uploads over a 90-day period. Seasonal variations affected adherence, with December being the lowest (47–69%) and August the highest (>85%). Monitoring multiple health parameters correlated with better adherence (>85%) compared to single-parameter tracking (50–74%). Conclusions: TM is a promising tool for HF management, but adherence differs by age, sex, and the complexity of monitoring. To optimize TM use, standardized adherence measures and tailored strategies are needed.

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.