Evolving role of echocardiography across the heart failure spectrum: from prevention to advanced management.

Heart failure (HF) is a global health burden that progresses through identifiable stages from at-risk individuals to symptomatic and advanced disease. Echocardiography has emerged as a cornerstone for precision, stage-based HF management, offering noninvasive evaluation across the entire HF continuum. This review provides an integrated perspective on the evolving role of echocardiography, including newer techniques such as global longitudinal strain (GLS), left atrial (LA) and right ventricular (RV) strain, and multi-organ ultrasound. In Stage A HF, strain imaging allows detection of early myocardial impairment in patients with hypertension, diabetes, or cancer therapy exposure, even when left ventricular ejection fraction is preserved. In Stage B HF, echocardiography identifies structural abnormalities and subclinical dysfunction, with GLS serving as a predictor of progression to symptomatic HF. In Stage C-D HF, echocardiographic parameters, including LA strain and RV function, provide prognostic insight and guide therapy decisions. Pre-discharge echocardiography offers better outcome prediction than admission assessment. Multi-organ approaches, such as lung ultrasound and intrarenal Doppler, complement cardiac imaging in assessing systemic congestion. Throughout all stages, echocardiography enables risk stratification, therapeutic guidance, and monitoring of disease progression or response to treatment. Future directions include artificial intelligence-assisted analysis, integration with remote monitoring, and multimodal imaging strategies to enhance diagnostic precision and individualized care. By aligning echocardiographic assessment with stage-specific HF pathophysiology, clinicians can improve outcomes through timely and tailored interventions.