Cardiogenic shock echocardiography or ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3] James Nasr[4]
Cardiogenic shock echocardiography or ultrasound
Overview
Echocardiography and point-of-care cardiac ultrasound are first-line imaging modalities in suspected cardiogenic shock. They help confirm cardiac dysfunction, define the dominant shock phenotype, identify mechanical complications, assess ventricular filling and forward flow, guide temporary mechanical circulatory support, and monitor treatment response.[1][2]
Echocardiography should not be interpreted in isolation. Findings should be integrated with the clinical examination, electrocardiogram, laboratory markers such as lactate, and invasive hemodynamic data when available. Comprehensive echocardiography is complementary to, not a replacement for, invasive hemodynamic assessment in selected patients with advanced or unclear shock physiology.[3]
Guideline recommendations
The 2025 ACC Expert Consensus Statement states that every patient suspected to be in cardiogenic shock should have, where available, a transthoracic echocardiogram or point-of-care cardiac ultrasound performed by an experienced clinician. Sonographic evidence of diminished RV or LV systolic function, cardiac tamponade, or acute valvular disease should prompt timely consultation.[1]
The 2017 AHA Scientific Statement recommends comprehensive transthoracic echocardiography in patients with cardiogenic shock to identify the dominant mechanism responsible for acute hemodynamic instability. Transesophageal echocardiography should be considered when transthoracic images are inadequate or the diagnosis remains uncertain.[2]
The 2021 AHA Scientific Statement on invasive management of acute myocardial infarction complicated by cardiogenic shock states that emergency echocardiography should be available 24 hours per day and performed as soon as possible, before or simultaneously with invasive evaluation. The initial study should focus on LV and RV systolic function, significant valvular disease, pericardial effusion or tamponade, and mechanical complications.[4]
The 2024 SCCM critical care ultrasonography guideline gives a conditional recommendation, with very low quality of evidence, for critical care ultrasound compared with usual care without ultrasound in adults with cardiogenic shock. The guideline notes that many patients may benefit from both critical care ultrasound and pulmonary artery catheterization.[3]
Diagnostic functions
| Function | Clinical utility |
|---|---|
| Confirm cardiac dysfunction | Identifies reduced LV or RV systolic function as the cause of shock and helps distinguish cardiogenic from non-cardiogenic shock.[1] |
| Define shock phenotype | Differentiates LV-dominant, RV-dominant, biventricular, LVOT obstruction, and mixed cardiogenic-distributive shock.[5] |
| Estimate forward flow | LVOT velocity-time integral provides a rapid estimate of stroke volume and cardiac output; low LVOT VTI indicates reduced forward flow.[6] |
| Detect mechanical complications | Identifies ventricular septal rupture, papillary muscle rupture with acute mitral regurgitation, free wall rupture, and pseudoaneurysm after myocardial infarction.[7] |
| Assess valvular pathology | Detects acute severe mitral regurgitation, aortic stenosis, aortic regurgitation, prosthetic valve dysfunction, and endocarditis-related valve failure. |
| Identify tamponade | Detects pericardial effusion and echocardiographic tamponade physiology, including chamber collapse and respiratory Doppler variation.[8] |
| Identify dynamic LVOT obstruction | Detects systolic anterior motion of the mitral valve, small LV cavity, hyperdynamic basal segments, and high LVOT gradient. |
| Estimate filling pressures and pulmonary pressures | E/e', mitral inflow pattern, IVC size and collapsibility, and tricuspid regurgitation velocity provide noninvasive estimates of filling pressure and pulmonary artery systolic pressure.[9] |
| Guide mechanical circulatory support | Confirms Impella position, assesses LV unloading during VA-ECMO, monitors aortic valve opening, and assists MCS weaning decisions.[10] |
Transthoracic, transesophageal, and focused cardiac ultrasound
| Modality | Strengths | Limitations | Use in cardiogenic shock |
|---|---|---|---|
| Transthoracic echocardiography | Noninvasive, portable, repeatable, rapidly available, no sedation required | Image quality may be limited in mechanically ventilated patients, obesity, dressings, chest tubes, or poor acoustic windows | First-line modality in suspected cardiogenic shock.[1][2] |
| Transesophageal echocardiography | Better visualization of posterior structures, mitral valve, prosthetic valves, aorta, intracardiac shunts, and mechanical complications | Semi-invasive; usually requires sedation or airway control; contraindicated in selected esophageal pathology | Use when TTE is nondiagnostic, images are inadequate, mechanical complication is suspected, prosthetic valve dysfunction is suspected, or intraoperative guidance is needed.[7][11] |
| Point-of-care cardiac ultrasound | Rapid bedside assessment of global LV function, RV size, pericardial effusion, and IVC; can be performed by trained clinicians | Qualitative or semi-quantitative; does not replace comprehensive echocardiography for complex hemodynamics, valve disease, or mechanical complications | Useful for immediate assessment in emergency or ICU settings when comprehensive echocardiography is not immediately available.[8][12] |
Left ventricular assessment
| Parameter | Measurement | Clinical significance |
|---|---|---|
| LVOT VTI | Pulsed-wave Doppler in the LVOT from an apical 5-chamber or 3-chamber view | Reflects forward stroke volume. In a Mayo Clinic study of 1,085 cardiogenic shock patients, LVOT VTI was the single best echocardiographic predictor of hospital mortality and outperformed LVEF.[6] |
| Left ventricular ejection fraction | Visual estimate, biplane Simpson method, or 3D echocardiography | Reduced LVEF is common but load-dependent and may not reflect forward flow in critical illness. A normal LVEF does not exclude cardiogenic shock when stroke volume is low.[13] |
| Stroke volume and cardiac output | Stroke volume = LVOT VTI × LVOT area; cardiac output = stroke volume × heart rate | Provides noninvasive estimate of forward flow and cardiac index; useful for shock phenotyping and serial response assessment. |
| Cardiac power output | CPO = (cardiac output × mean arterial pressure) / 451 | Integrates flow and pressure; a strong hemodynamic correlate of mortality that can be estimated noninvasively using echocardiographic cardiac output and cuff MAP.[13] |
| Regional wall motion abnormalities | Segmental wall motion assessment in multiple views | Suggests ischemic etiology, localizes infarct territory, and helps identify acute coronary syndrome-related shock. |
| E/e' ratio | Early mitral inflow velocity divided by early diastolic annular velocity | Estimates LV filling pressures. Elevated E/e' suggests elevated left-sided filling pressures.[13] |
| LV size and volumes | LV dimensions and end-diastolic/end-systolic volumes | Helps distinguish acute from chronic LV dysfunction; small hyperdynamic LV may suggest hypovolemia or dynamic LVOT obstruction rather than primary LV pump failure. |
Right ventricular assessment
Right ventricular assessment is essential because RV-dominant and biventricular shock require different management strategies from isolated LV-dominant shock. No single RV parameter is sufficient; a multiparametric approach is recommended.[14][15]
| Parameter | Normal threshold | Abnormal finding | Clinical significance |
|---|---|---|---|
| TAPSE | ≥17 mm | <17 mm | Simple longitudinal RV systolic function marker; load dependent and should not be used alone.[15] |
| RV fractional area change | ≥35% | <35% | Reflects global RV systolic function; requires good RV-focused apical imaging.[15] |
| Tissue Doppler S' velocity | ≥9.5 cm/s | <9.5 cm/s | Longitudinal systolic velocity of the tricuspid annulus; reduced values suggest RV systolic dysfunction.[15] |
| RV free wall longitudinal strain | Approximately −29% ± 4.5% | Less negative strain, often >−20% | Less angle dependent than TAPSE and may add prognostic information.[14] |
| RV size | RV smaller than LV in standard views | RV dilation, RV/LV ratio >1, or septal bowing | Suggests acute RV pressure or volume overload, pulmonary embolism, RV infarction, pulmonary hypertension, or post-LVAD RV failure. |
| TAPSE/PASP ratio | Variable by disease | Low ratio | Marker of RV-pulmonary artery coupling; lower values suggest RV-PA uncoupling and worse RV performance.[14] |
| IVC size and collapsibility | Small or normal IVC with respiratory collapse | Dilated IVC with reduced collapse | Suggests elevated right atrial pressure; interpret cautiously in mechanical ventilation and high intrathoracic pressure states. |
Hemodynamic phenotyping by echocardiography
| Phenotype | Echocardiographic features | Clinical implication |
|---|---|---|
| LV-dominant shock | Reduced LVEF, low LVOT VTI, regional or global wall motion abnormalities, elevated filling pressures, mitral regurgitation, preserved or mildly reduced RV function | Common in acute myocardial infarction-related and acute decompensated heart failure-related shock; may require LV-targeted support.[5] |
| RV-dominant shock | RV dilation, reduced TAPSE, reduced RV FAC, low S', septal bowing into LV, dilated IVC, relatively preserved LV systolic function | Suggests RV infarction, pulmonary embolism, pulmonary hypertension, post-LVAD RV failure, or isolated RV failure; requires RV-specific management.[9] |
| Biventricular shock | Both LV and RV dysfunction, low LVOT VTI, RV dilation, elevated filling pressures bilaterally | Associated with severe congestion, high organ-failure burden, and potential need for advanced or biventricular support. |
| Dynamic LVOT obstruction | Small LV cavity, hyperdynamic basal segments, systolic anterior motion of the mitral valve, high LVOT gradient | May occur in stress cardiomyopathy, hypertrophic cardiomyopathy, or hypovolemia; management differs from low-contractility pump failure and may require volume, afterload support, and avoidance of inotropes. |
| Mixed cardiogenic-distributive shock | Cardiac dysfunction with vasodilatory physiology, hyperdynamic features in some territories, or discordance between cardiac function and shock severity | Suggests sepsis, systemic inflammatory response, post-cardiac arrest syndrome, or mixed shock; ultrasound findings should be integrated with invasive hemodynamics and laboratory data. |
Mechanical complications of myocardial infarction
Echocardiography is the primary diagnostic imaging modality for mechanical complications of acute myocardial infarction. Transthoracic echocardiography is recommended for suspected myocardial infarction-related mechanical complications, and TEE should be used when TTE is nondiagnostic or when detailed anatomic characterization is needed.[7]
| Complication | Key echocardiographic findings | Additional considerations |
|---|---|---|
| Ventricular septal rupture | Color Doppler left-to-right shunt across the interventricular septum; 2D imaging defines defect size, location, and morphology; RV and pulmonary artery dilation may reflect acute volume overload | Color Doppler echocardiography for ventricular septal rupture has been reported to have sensitivity and specificity as high as 100% and is superior to 2D imaging alone. Combined 2D Doppler TTE was diagnostic in 95% of cases in a Mayo Clinic series; TEE was diagnostic in all patients in whom it was applied.[16][17][18] |
| Papillary muscle rupture with acute mitral regurgitation | Severe, often eccentric mitral regurgitation; flail leaflet; mobile ruptured papillary muscle head in the LV or prolapsing into the LA; normal LV size with severe MR suggests an acute event | TTE may be nondiagnostic in partial papillary muscle rupture; TEE has high diagnostic sensitivity and should be performed when suspicion remains high.[7] |
| Free wall rupture | Pericardial effusion, echogenic hemopericardium, RV diastolic collapse, respiratory variation in mitral inflow, plethoric IVC, or visible flow through a wall defect | Rapid echocardiography is essential in sudden collapse or electromechanical dissociation after myocardial infarction. |
| Left ventricular pseudoaneurysm | Aneurysm cavity communicating with LV through a narrow neck; to-and-fro flow across the neck on color Doppler | CT or cardiac MRI may provide additional anatomic characterization when the patient is stable. |
Echocardiography for mechanical circulatory support
Impella devices
The 2022 AHA Scientific Statement on temporary mechanical circulatory support states that echocardiography is the main imaging modality for LV Impella adjustments and that Impella implanting centers should have 24-hour echocardiography access.[10] For Impella CP, the inlet, or "teardrop" cage, should ideally be located approximately 3.5 to 4.0 cm below the aortic annulus. The measurement should be from the aortic valve to the cage of the inflow opening, not including the pigtail; including the pigtail is a classic mistake that may lead to erroneous pullback of a correctly positioned device. Measurements should be made in more than one plane because the catheter is curved.[19][20]
Echocardiography should be used to reassess Impella position when suction alarms, worsening hemodynamics, hemolysis, ventricular arrhythmias, worsening mitral or aortic regurgitation, or suspected device migration occurs.[21]
Pre-implantation echocardiographic assessment should evaluate for findings that may preclude or complicate Impella placement, including mechanical aortic valve, LV thrombus, heavily calcified or severely stenosed aortic valve, LVOT narrowing from hypertrophic cardiomyopathy or subaortic stenosis, redundant myxomatous mitral valve that may obstruct the device inlet, and severe aortic regurgitation, which may cause recirculation and ineffective LV emptying. A preexisting ventricular septal defect may worsen right-to-left shunting.[22][23][21]
VA-ECMO
Echocardiography is central to VA-ECMO management. It can assess LV unloading, aortic valve opening, intracardiac stasis, ventricular distension, RV function, cannula position, and readiness for weaning.[21]
| VA-ECMO assessment | Echocardiographic finding | Clinical significance |
|---|---|---|
| LV unloading and distension | LV dilation, hypocontractile LV, nonopening aortic valve, spontaneous echo contrast or stasis within the LV, severe mitral regurgitation, and pulmonary venous congestion. Lack of arterial pulsatility is an additional clue to a closed aortic valve. | LV distension suggests inadequate unloading and may prompt LV venting strategies. Early LV unloading within 2 hours of ECMO initiation has been associated with lower 30-day mortality compared with delayed unloading.[20][11] |
| Aortic valve opening | Intermittent or persistent aortic valve closure | Persistent aortic valve closure suggests inadequate native ejection and risk of LV distension or aortic root thrombosis.[10] |
| Cannula position | Drainage cannula position in the right atrium or caval system; return cannula position depending on configuration | Confirms appropriate cannula course and helps troubleshoot inadequate flow. |
| Weaning readiness | Recovery of LV and RV function, improved LVOT VTI, improved tissue Doppler systolic velocities | Helps identify readiness for ECMO flow reduction and explantation.[21] |
Intra-aortic balloon pump
Chest radiography and fluoroscopy are the primary modalities for intra-aortic balloon pump position. Echocardiography can assess the hemodynamic effects of counterpulsation and evaluate complications or contraindicating pathology such as significant aortic regurgitation.
Weaning from temporary mechanical circulatory support
The 2022 AHA Scientific Statement on temporary mechanical circulatory support states that weaning may be considered after improvement in cardiac dysfunction, end-organ hypoperfusion, intravascular volume status, vasoactive support requirements, and echocardiographic contractility.[10]
The 2024 ASE recommendations identify echocardiographic features associated with successful VA-ECMO weaning, including LVEF ≥20-25%, LVOT VTI ≥10 cm, mitral lateral S' ≥6 cm/s, and evidence of RV functional recovery.[21] After temporary mechanical circulatory support explantation, comprehensive echocardiography should establish a new baseline of ventricular and valvular function and assess for device-related injury.[21]
Lung ultrasound as a complement
Point-of-care lung ultrasound complements cardiac ultrasound in cardiogenic shock by assessing pulmonary congestion, pleural effusions, and pneumothorax. B-lines support pulmonary congestion when interpreted with cardiac findings and clinical context. In a study of 308 patients with ST-elevation myocardial infarction, a combined classification using lung ultrasound and LVOT VTI predicted in-hospital mortality and cardiogenic shock development within 24 hours.[24]
Absence of B-lines does not exclude cardiogenic shock, particularly in RV-dominant shock, cold-dry shock, or early shock before radiographic or sonographic pulmonary congestion develops.
Prognostic echocardiographic findings
| Parameter | Prognostic significance |
|---|---|
| LVOT VTI | Single best echocardiographic predictor of hospital mortality in a Mayo Clinic study of 1,085 cardiogenic shock patients; remained strongly associated with mortality after adjustment.[6] |
| Stroke volume index | Outperformed LVEF for mortality prediction in noninvasive hemodynamic assessment of cardiac ICU patients with shock.[13] |
| LVEF | Lower LVEF is associated with worse outcomes, but LVEF is load dependent and less informative than forward-flow indices in some critically ill patients. |
| RV dysfunction | Moderate or severe RV systolic dysfunction is common in cardiogenic shock and is associated with worse outcomes.[6] |
| Cardiac power output | Integrates flow and pressure and is a strong hemodynamic marker of shock severity and mortality risk.[13] |
| Severe mitral regurgitation | Suggests worse prognosis and may identify a mechanical or structural driver of shock requiring urgent intervention. |
| Biventricular dysfunction | Carries worse prognosis than isolated LV or RV dysfunction and may require advanced or biventricular support. |
| Global longitudinal strain | Emerging parameter with superior prognostic value to LVEF in acute heart failure populations; in a study of 4,172 patients with acute heart failure, each 1% increase in GLS was associated with a 5% decreased risk for mortality. GLS is not yet incorporated into standard cardiogenic shock staging algorithms but may provide incremental prognostic information beyond LVEF.[25][26] |
Serial echocardiography
Echocardiography should be repeated when shock worsens, vasoactive or mechanical support is escalated or de-escalated, arrhythmias or device alarms occur, volume status changes, mechanical complications are suspected, or myocardial recovery is being assessed. Serial studies should focus on LVOT VTI, LV and RV systolic function, filling pressures, valve function, pericardial effusion, aortic valve opening during VA-ECMO, and device position.
Practical echocardiography approach
- Perform TTE or point-of-care cardiac ultrasound as soon as possible in every patient with suspected cardiogenic shock.
- Assess LV systolic function, RV systolic function, regional wall motion abnormalities, LVOT VTI, and stroke volume.
- Assess filling pressures and congestion using mitral inflow, E/e', IVC size and collapsibility, lung ultrasound, and Doppler findings.
- Exclude mechanical complications after myocardial infarction, including ventricular septal rupture, papillary muscle rupture, acute severe mitral regurgitation, free wall rupture, and pseudoaneurysm.
- Evaluate for tamponade, dynamic LVOT obstruction, severe valvular disease, and acute RV failure.
- Use TEE when TTE is nondiagnostic or when mechanical complications, prosthetic valve dysfunction, or intraoperative guidance are relevant.
- Before Impella placement, evaluate for mechanical aortic valve, LV thrombus, severe aortic stenosis, LVOT obstruction, severe aortic regurgitation, redundant myxomatous mitral valve, and preexisting ventricular septal defect.
- Use echocardiography to guide Impella position, monitor VA-ECMO unloading, and assess MCS weaning readiness.
- Repeat echocardiography serially to monitor response, recovery, device complications, and new structural pathology.
Common pitfalls
- Relying on LVEF alone without measuring LVOT VTI or stroke volume
- Assuming preserved LVEF excludes cardiogenic shock
- Failing to assess RV function in every patient with cardiogenic shock
- Missing dynamic LVOT obstruction before giving inotropes or escalating support
- Assuming absence of a murmur excludes papillary muscle rupture or ventricular septal rupture
- Not performing TEE when TTE is nondiagnostic and mechanical complication is suspected
- Failing to reassess Impella position when suction alarms, hemolysis, arrhythmias, or hemodynamic deterioration occur
- Including the pigtail in the Impella inlet-to-aortic valve distance measurement, which may lead to erroneous pullback of a correctly positioned device
- Not assessing aortic valve opening and LV unloading during VA-ECMO
- Treating echocardiography as a one-time test rather than a serial monitoring tool
- Interpreting echocardiography without integrating clinical, laboratory, ECG, and invasive hemodynamic data
References
- ↑ 1.0 1.1 1.2 1.3 Sinha SS, Morrow DA, Kapur NK, Kataria R, Roswell RO (2025). "2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Evaluation and Management of Cardiogenic Shock". Journal of the American College of Cardiology. 85 (16): 1618–1641. doi:10.1016/j.jacc.2025.02.018.
- ↑ 2.0 2.1 2.2 van Diepen S, Katz JN, Albert NM; et al. (2017). "Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association". Circulation. 136 (16): e232–e268. doi:10.1161/CIR.0000000000000525.
- ↑ 3.0 3.1 Díaz-Gómez JL, Sharif S, Ablordeppey E; et al. (2025). "Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024". Critical Care Medicine. 53 (2): e447–e458. doi:10.1097/CCM.0000000000006530.
- ↑ Henry TD, Tomey MI, Tamis-Holland JE; et al. (2021). "Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association". Circulation. 143 (15): e815–e829. doi:10.1161/CIR.0000000000000959.
- ↑ 5.0 5.1 Balik M, Ng W, Dugar S (2026). "From Guideline to Precision: Echocardiography in the Management of Cardiogenic Shock". Current Opinion in Critical Care. doi:10.1097/MCC.0000000000001400.
- ↑ 6.0 6.1 6.2 6.3 Jentzer JC, Tabi M, Wiley BM, Singam NSV, Anavekar NS (2022). "Echocardiographic Correlates of Mortality Among Cardiac Intensive Care Unit Patients With Cardiogenic Shock". Shock. 57 (3): 336–343. doi:10.1097/SHK.0000000000001877.
- ↑ 7.0 7.1 7.2 7.3 Damluji AA, van Diepen S, Katz JN; et al. (2021). "Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association". Circulation. 144 (2): e16–e35. doi:10.1161/CIR.0000000000000985.
- ↑ 8.0 8.1 Labovitz AJ, Noble VE, Bierig M; et al. (2010). "Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians". Journal of the American Society of Echocardiography. 23 (12): 1225–1230. doi:10.1016/j.echo.2010.10.005.
- ↑ 9.0 9.1 Konstam MA, Kiernan MS, Bernstein D; et al. (2018). "Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association". Circulation. 137 (20): e578–e622. doi:10.1161/CIR.0000000000000560.
- ↑ 10.0 10.1 10.2 10.3 Geller BJ, Sinha SS, Kapur NK; et al. (2022). "Escalating and De-Escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association". Circulation. 146 (6): e50–e68. doi:10.1161/CIR.0000000000001076.
- ↑ 11.0 11.1 Rong LQ, Shore-Lesserson L, Belani K; et al. (2025). "Considerations of Intraoperative Transesophageal Echocardiography During Adult Cardiac Surgery: A Scientific Statement From the American Heart Association". Circulation. 152 (2): 129–145. doi:10.1161/CIR.0000000000001342.
- ↑ Spencer KT, Flachskampf FA (2019). "Focused Cardiac Ultrasonography". JACC: Cardiovascular Imaging. 12 (7 Pt 1): 1243–1253. doi:10.1016/j.jcmg.2018.12.036.
- ↑ 13.0 13.1 13.2 13.3 13.4 Jentzer JC, Wiley BM, Anavekar NS; et al. (2021). "Noninvasive Hemodynamic Assessment of Shock Severity and Mortality Risk Prediction in the Cardiac Intensive Care Unit". JACC: Cardiovascular Imaging. 14 (2): 321–332. doi:10.1016/j.jcmg.2020.05.038.
- ↑ 14.0 14.1 14.2 Hahn RT, Lerakis S, Delgado V; et al. (2023). "Multimodality Imaging of Right Heart Function: JACC Scientific Statement". Journal of the American College of Cardiology. 81 (19): 1954–1973. doi:10.1016/j.jacc.2023.03.392.
- ↑ 15.0 15.1 15.2 15.3 Rudski LG, Lai WW, Afilalo J; et al. (2010). "Guidelines for the Echocardiographic Assessment of the Right Heart in Adults". Journal of the American Society of Echocardiography. 23 (7): 685–713. doi:10.1016/j.echo.2010.05.010.
- ↑ Birnbaum Y, Fishbein MC, Blanche C, Siegel RJ (2002). "Ventricular Septal Rupture after Acute Myocardial Infarction". The New England Journal of Medicine. 347 (18): 1426–1432. doi:10.1056/NEJMra020228.
- ↑ Fortin DF, Sheikh KH, Kisslo J (1991). "The Utility of Echocardiography in the Diagnostic Strategy of Postinfarction Ventricular Septal Rupture: A Comparison of Two-Dimensional Echocardiography Versus Doppler Color Flow Imaging". American Heart Journal. 121 (1 Pt 1): 25–32. doi:10.1016/0002-8703(91)90951-D.
- ↑ Kishon Y, Iqbal A, Oh JK; et al. (1993). "Evolution of Echocardiographic Modalities in Detection of Postmyocardial Infarction Ventricular Septal Defect and Papillary Muscle Rupture: Study of 62 Patients". American Heart Journal. 126 (3 Pt 1): 667–675. doi:10.1016/0002-8703(93)90417-8.
- ↑ Balthazar T, Vandenbriele C, Verbrugge FH; et al. (2021). "Managing Patients With Short-Term Mechanical Circulatory Support: JACC Review Topic of the Week". Journal of the American College of Cardiology. 77 (9): 1243–1256. doi:10.1016/j.jacc.2020.12.054.
- ↑ 20.0 20.1 Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM (2023). "The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support". Journal of Cardiac Failure. 29 (3): 304–374. doi:10.1016/j.cardfail.2022.11.003.
- ↑ 21.0 21.1 21.2 21.3 21.4 21.5 Estep JD, Nicoara A, Cavalcante J; et al. (2024). "Recommendations for Multimodality Imaging of Patients With Left Ventricular Assist Devices and Temporary Mechanical Support: Updated Recommendations From the American Society of Echocardiography". Journal of the American Society of Echocardiography. 37 (9): 820–871. doi:10.1016/j.echo.2024.06.005.
- ↑ Rihal CS, Naidu SS, Givertz MM; et al. (2015). "2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care". Journal of the American College of Cardiology. 65 (19): e7–e26. doi:10.1016/j.jacc.2015.03.036.
- ↑ Nicoara A, Skubas N, Ad N; et al. (2020). "Guidelines for the Use of Transesophageal Echocardiography to Assist With Surgical Decision-Making in the Operating Room: A Surgery-Based Approach". Journal of the American Society of Echocardiography. 33 (6): 692–734. doi:10.1016/j.echo.2020.03.002.
- ↑ Machado GP, Telo GH, de Araujo GN; et al. (2024). "A Combination of Left Ventricular Outflow Tract Velocity Time Integral and Lung Ultrasound to Predict Mortality in ST Elevation Myocardial Infarction". Internal and Emergency Medicine. 19 (8): 2167–2176. doi:10.1007/s11739-024-03719-z.
- ↑ Park JJ, Park JB, Park JH, Cho GY (2018). "Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure". Journal of the American College of Cardiology. 71 (18): 1947–1957. doi:10.1016/j.jacc.2018.02.064.
- ↑ Kalam K, Otahal P, Marwick TH (2014). "Prognostic Implications of Global LV Dysfunction: A Systematic Review and Meta-Analysis of Global Longitudinal Strain and Ejection Fraction". Heart. 100 (21): 1673–1680. doi:10.1136/heartjnl-2014-305538.