diagnostics Review Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application Simona Sperlongano 1 , Antonello D’Andrea 2, * , Donato Mele 3 , Vincenzo Russo 1 , Valeria Pergola 3 , Andreina Carbone 1 , Federica Ilardi 4 , Marco Di Maio 5 , Roberta Bottino 1 , Francesco Giallauria 6 , Eduardo Bossone 7 and Paolo Golino 1   Citation: Sperlongano, S.; D’Andrea, A.; Mele, D.; Russo, V.; Pergola, V.; Carbone, A.; Ilardi, F.; Di Maio, M.; Bottino, R.; Giallauria, F.; et al. Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application. Diagnostics 2021, 11, 892. https://doi.org/10.3390/ diagnostics11050892 Academic Editor: Andrea D. Annoni Received: 8 April 2021 Accepted: 13 May 2021 Published: 17 May 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; sperlongano.simona@gmail.com (S.S.); vincenzo.russo@unicampania.it (V.R.); andr.carbone@gmail.com (A.C.); ro.bottino@hotmail.com (R.B.); paolo.golino@unicampania.it (P.G.) 2 Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, 84014 Salerno, Italy 3 Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, 35100 Padova, Italy; donato.mele@unipd.it (D.M.);valeria.pergola@aopd.veneto.it (V.P.) 4 Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; fedeilardi@gmail.com 5 Division of Cardiology, Maria SS. Addolorata Hospital, Eboli, 84025 Salerno, Italy; marcodimaio88@gmail.com 6 Department of Translational Medical Sciences, Federico II University of Naples, 80138 Naples, Italy; giallauriafrancesco@gmail.com 7 Division of Cardiology, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; ebossone@hotmail.com * Correspondence: antonellodandrea@libero.it; Tel.: +39-081-9213111 Abstract: Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy. Keywords: heart failure (HF); heart failure with preserved ejection fraction (HFpEF); cardiac resyn- chronization therapy (CRT); speckle tracking echocardiography (STE); left ventricular strain; color Doppler flow mapping (CDFM); left ventricular vortex 1. Introduction Heart failure (HF) is a clinical syndrome characterized by dyspnea, fatigue, and limitation of physical activity, due to reduced cardiac output and/or elevated ventricular filling pressures at rest or during stress. It has a prevalence of about 1–2% in the adult population of developed countries, reaching ≥10% among people >70 years of age [1]. Once developed, HF results in significant cardiovascular morbidity and mortality. More than one million people are annually hospitalized for HF, with a 5-year mortality rate of approximately 50% [2]. HF is suspected by clinical history, symptoms, physical examination, electrocardio- gram findings, and natriuretic peptides’ values. However, since symptoms and signs are Diagnostics 2021, 11, 892. https://doi.org/10.3390/diagnostics11050892 https://www.mdpi.com/journal/diagnostics