[Echocardiography in cardiology-Basic tool, current developments and future perspectives]

Despite advances in computed tomography (CT) and magnetic resonance imaging (MRI), transthoracic echocardiography remains the central imaging method in cardiology and internal medicine. Key advantages are ubiquitous availability, repeatability and the direct linkage between findings and symptoms at the bedside. In daily practice it answers questions relevant to treatment with respect to pump function, pericardial effusion or tamponade, relevant valvular diseases, heart failure with preserved ejection fraction (HFpEF), pulmonary hypertension and the hemodynamic profile in shock, sepsis or circulatory instability. A prerequisite for reliable diagnostics is a standardized, guideline-conform examination. In valvular diseases, the goal is not only the detection but also the precise quantification of the disease and assessment of the treatment urgency. This particularly applies to challenging constellations, such as the frequently underestimated low-flow low-gradient aortic valve stenosis. In the acute setting, focused cardiac ultrasound can provide a rapid orientation but it does not replace a complete transthoracic examination. The limitations of the method reside less in the technique itself than in insufficient standardization, misapplication and poor image quality. Current and future developments will further enhance the diagnostic value. Examples are artificial intelligence (AI)-assisted assessment with automated analysis of various parameters, pattern recognition for disease detection, speckle tracking strain and accompanying refinements, left atrial strain for advanced assessment of the diastolic function, 3D echocardiography, and shear wave imaging for estimating myocardial stiffness. Echocardiography thus remains an indispensable, dynamic and effective method. Critical factors are standardized workflows, guideline-conform quantification and the interpretation of findings within the clinical context.