Assessment of CMR Feature-Tracking Age- and Sex-Dependent Right Ventricular Strain in a Healthy Caucasian Cohort.

Right ventricular (RV) strain offers crucial diagnostic insights in cardiovascular and pulmonary disorders. Nonetheless, the absence of established reference values impedes its clinical implementation. Utilizing CMR-feature tracking, age- and gender-dependent RV strains were systematically assessed in 175 heart-healthy Caucasians, 97 females, median 32.5 years. RV global longitudinal strain (GLS) was greater in females than males (median -26.8% (-28.3;-24.1) vs. -24.4 ± 3.0%; p < 0.001), whereby radial and circumferential strain remained comparable. Age subgroups exhibited increased RV-GLS for group B (30-50 years) (-26.0 ± 3.1% vs. -24.4 ± 3.2%; p = 0.011) and group C (> 50 years) (-26.7 ± 2.3% vs. -24.4 ± 3.2%; p < 0.001) compared to group A (< 30 years). High intra-class correlation coefficients (ICC) were exhibited by intrarater variability (ICC = 0.86-0.95) and moderate levels for interrater variability (ICC = 0.50-0.73). CMR-feature tracking provides a fair quantification method of age- and gender-specific normal RV strain values, demonstrating that higher RV-GLS is linked to female gender and advancing age within a healthy Caucasian cohort.

Unraveling the Effect of Strain Rate and Temperature on the Heterogeneous Mechanical Behavior of Polymer Nanocomposites via Atomistic Simulations and Continuum Models.

Polymer nanocomposites are characterized by heterogeneous mechanical behavior and performance, which is mainly controlled by the interaction between the nanofiller and the polymer matrix. Optimizing their material performance in engineering applications requires understanding how both the temperature and strain rate of the applied deformation affect mechanical properties. This work investigates the effect of strain rate and temperature on the mechanical properties of poly(ethylene oxide)/silica (PEO/SiO2) nanocomposites, revealing their behavior in both the melt and glassy states, via atomistic molecular dynamics simulations and continuum models. In the glassy state, the results indicate that Young's modulus increases by up to 99.7% as the strain rate rises from 1.0 × 10-7 fs-1 to 1.0 × 10-4 fs-1, while Poisson's ratio decreases by up to 39.8% over the same range. These effects become even more pronounced in the melt state. Conversely, higher temperatures lead to an opposing trend. A local, per-atom analysis of stress and strain fields reveals broader variability in the local strain of the PEO/SiO2 nanocomposites as temperature increases and/or the deformation rate decreases. Both interphase and matrix regions lose rigidity at higher temperatures and lower strain rates, blurring their distinctiveness. The results of the atomistic simulations concerning the elastic modulus and Poisson's ratio are in good agreement with the predictions of the Richeton-Ji model. Additionally, these findings can be leveraged to design advanced polymer composites with tailored mechanical properties and could optimize structural components by enhancing their performance under diverse engineering conditions.

Utility of Magnetocardiography and Stress Speckle Tracking in Detection of Coronary Artery Disease.

Introduction: Coronary artery disease (CAD) is a leading cause of death and disability in developed countries. While exercise testing is recommended for diagnosing stable angina pectoris, its limited sensitivity and specificity have been questioned. Myocardial strain is a promising predictor of significant CAD. Aim: To evaluate the utility of myocardial strain obtained by 2D speckle tracking at rest and under stress combined with stress magnetocardiography for detecting CAD in patients with stable or low-risk unstable angina pectoris. Methods: A total of 108 patients meeting the inclusion criteria underwent coronary angiography within 48 h of admission. Myocardial strain was assessed using 2D speckle tracking at rest and during dobutamine stress alongside stress magnetocardiography. Results: Global longitudinal strain at stress showed a moderate correlation with significant CAD (r = 0.41, p <0.0001) and with coronary occlusion severity (r = 0.62, p <0.0001). Strain at stress had a sensitivity of 74.1% and specificity of 76.7% for detecting CAD at a cut-off value of -19.1. The ST fluctuation rate from magnetocardiography demonstrated the highest sensitivity for CAD detection. Conclusions: Longitudinal strain parameters and stress magnetocardiography are effective non-invasive methods for predicting CAD in patients with stable angina, potentially reducing the need for invasive assessments.

Investigation of dynamic responses of skin simulant against fragment impact through experiments and concurrent computational modeling.

Perforation of the skin by fragment impact is a key determinant of the severity of an injury and incapacitation during modern asymmetric warfare. Computational models validated against experimental data are thus desired for simulating the responses of a skin simulant against fragment impact. Toward this end, experiments and concurrent computational modeling were used to investigate the dynamic responses of the skin simulant against fragment impact. Fragment simulating projectiles (FSPs) of masses 1.10 g and 2.79 g were considered herein, and the responses of the skin simulant were investigated in terms of the threshold velocity, energy density, peak displacement, and failure mechanisms. The results illustrate numerous salient aspects. The skin simulant failure involved cavity shearing followed by elastic hole enlargement, and these results were sensitive to the strain rate. The best agreement between the simulated and experimental results was achieved when the input stress-strain curves to the simulation were based on the full spectrum of strain rates. When a single stress-strain curve corresponding to a specific strain rate was used as the input, the threshold velocity and peak displacement of the skin simulant were either underpredicted or overpredicted depending on the strain rate considered. The threshold velocity was also sensitive to the input failure strain; here, the best agreement was obtained when the failure strain was based on the theoretical limiting strain. When the FSP materials were changed to plastics, the threshold velocities increased by up to 33%; however, the energy densities and generated stresses exceeded the contusion and laceration thresholds of the skin.

Echocardiographic Strain Abnormalities Precede Left Ventricular Hypertrophy Development in Hypertrophic Cardiomyopathy Mutation Carriers.

Hypertrophic cardiomyopathy (HCM) is a genetic disease characterized by unexplained left ventricular hypertrophy (LVH), diastolic dysfunction, and increased sudden-death risk. Early detection of the phenotypic expression of the disease in genetic carriers without LVH (Gen+/Phen-) is crucial for emerging therapies. This clinical study aims to identify echocardiographic predictors of phenotypic development in Gen+/Phen-. Sixteen Gen+/Phen- (one subject with troponin T, six with myosin heavy chain-7, and nine with myosin-binding protein C3 mutations), represented the study population. At first and last visit we performed comprehensive 2D speckle-tracking strain echocardiography. During a follow-up of 8 ± 5 years, five carriers developed LVH (LVH+). At baseline, these patients were older than those who did not develop LVH (LVH-) (30 ± 8 vs. 15 ± 8 years, p = 0.005). LVH+ had reduced peak global strain rate during the isovolumic relaxation period (SRIVR) (0.28 ± 0.05 vs. 0.40 ± 0.11 1/s, p = 0.048) and lower global longitudinal strain (GLS) (-19.8 ± 0.4 vs. -22.3 ± 1.1%; p < 0.0001) than LVH- at baseline. SRIVR and GLS were not correlated with age (overall, p > 0.08). This is the first HCM study investigating subjects before they manifest clinically significant or relevant disease burden or symptomatology, comparing at baseline HCM Gen+/Phen- subjects who will develop LVH with those who will not. Furthermore, we identified highly sensitive, easily obtainable, age- and load-independent echocardiographic predictors of phenotype development in HCM gene carriers who may undergo early preventive treatment.

Computational modeling and uncertainty prediction of hyperelastic constitutive responses of damaged brain tissue under different temperature and strain rates.

The effect of strain rate and temperature on the hyperelastic material stress-strain characteristics of the damaged porcine brain tissue is evaluated in this present work. The desired constitutive responses are obtained using the commercially available finite element (FE) tool ABAQUS, utilizing 8-noded brick elements. The model's accuracy has been verified by comparing the results from the previously published literature. Further, the stress-strain behavior of the brain tissue is evaluated by varying the damages at various strain rates and temperatures (13, 20, 27, and 37°C) under compression test. Additionally, the sensitivity analysis of the model is computed to check the effect of input parameters, that is, the temperature, strain rate, and damages on the material properties (shear modulus). The modeling and discussion sections enumerate the inclusive features and model capabilities.

Resting segmental speckle tracking strain and strain rate in stable coronary artery disease and revascularized myocardial infarction.

Patients with acute coronary artery disease (CAD) exhibit reduced global and regional strain and strain rate (S/SR). However, knowledge about segmental S/SR in stable CAD patients is still limited. This study aimed to investigate whether resting segmental S/SR measurements differ in patients with chronic chest pain who have normal coronary arteries or stenotic coronary arteries, and to compare these measurements to those in patients with revascularized myocardial infarction (MI). We prospectively enrolled 510 patients with chronic chest pain referred for coronary computed tomography angiography (CCTA) and 102 patients revascularized after MI. All participants underwent transthoracic echocardiography featuring S/SR analysis. In addition to the patients with MI, patients with suspected CAD based on CCTA findings subsequently underwent invasive coronary angiography (CAG). We assessed global longitudinal strain (GLS) and averaged segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), and post systolic shortening (PSS). We also determined functionally reduced segment percentages using differing S/SR cut-off values. There were significant disparities in all average segmental S/SR metrics between the No-CAD and MI groups. SRe was the only S/SR metric that differed significantly between the No-CAD and PCI groups. Differences in SRe, PLS and GLS measurements were observed between the No-CAD and CABG groups. The proportion of diminished segmental S/SR mirrored these findings. For the percentage of pathological segments with varying cut-off values, segmental SRe below 1.5 s- 1 displayed the most marked difference among the four groups (p < 0.001). Revascularized MI patients or those referred to CABG present with diminished segmental S/SR values. However, among patients with chronic chest pain, only segmental SRe discerns subtle disparities between the No-CAD and the PCI group. The diagnostic accuracy of SRe warrants further exploration in subsequent studies.

Modeling Strain Hardening of Metallic Materials with Sigmoidal Function Considering Temperature and Strain Rate Effects.

This study uses a sigmoidal function to describe the plastic strain hardening of metallic materials, considering temperature and strain rate effects. The effectiveness of this approach is evaluated and systematically compared with other hardening laws. Incorporating temperature and strain rate effects into the parameters of this sigmoidal-type hardening law enables a more precise description and prediction of the plastic deformation of materials under different combinations of temperature and strain rate. The temperature effect is coupled using a simplified Arrhenius model, and the strain rate effect is coupled with a modified Johnson-Cook model. The sigmoidal-type hardening law is integrated with an asymmetric yield criterion to address complex behavior, such as anisotropy and strength differential effects. The calibration and validation of the constitutive model involve examining uniaxial tensile/compressive flow curves in various directions and biaxial tensile/compressive flow curves for diverse metallic alloys, proving the proposed model's broad applicability.

Investigation of Toughening Mechanisms in Elastomeric Polycarbonate Blends through Morphological and Mechanical Characterization at Small and Medium Strain Rates.

Despite polycarbonate (PC) being a widely used engineering plastic, its notch and crack sensitivity pose challenges in critical applications. To address this, PC was blended with elastomeric polymers to explore the improvement in toughness. This study systematically investigates the toughening mechanisms of PC blended with acrylonitrile-butadiene-styrene (ABS), copolyether ester elastomer (COPE), and ABS and styrene-ethylene-butylene-styrene (SEBS) copolymer grafted with maleic anhydride (MA). The morphology and mechanical behavior were evaluated under quasi-static and medium-strain-rate tensile tests and Charpy impact tests using optical, electronic, and atomic force microscopy and Raman mapping spectroscopy. The morphological analysis reveals cavitation and crazing phenomena for COPE and SEBS-g-MA systems, and mostly debonding for ABS, indicating an improvement in toughening. While the addition of ABS improves the PC plastic deformation, modifying ABS with maleic anhydride enhances the elastic modulus. Blending PC with SEBS-g-MA increases the strain at break, and the addition of COPE significantly improves the deformation behavior of PC (by around 115%). This comparative study provides valuable insights into the performance of different PC-elastomer blends under similar conditions, supporting the selection of appropriate materials for given applications.

Fracture Analysis of Highly Flexible Adhesives: Cohesive Zone Modelling across a Wide Spectrum of Temperatures and Strain Rates.

This study focuses on the prediction of the fracture mechanics behaviour of a highly flexible adhesive (with a tensile elongation of 90%), since this type of adhesive is becoming widely used in automotive structures due to their high elongation at break and damping capacity. Despite their extensive applications, the understanding of their fracture mechanics behaviour under varying loading rates and temperatures remains limited in the literature. In addition, current prediction models are also unable to accurately predict their behaviour due to the complex failure mechanism that such bonded joints have. This study aims to determine whether a simple triangular cohesive zone model (CZM), which predefines the crack path, can reproduce the load-displacement curves of adhesives under various temperatures and strain rates. To achieve this, a calibrated CZM is used, adapting the model for reference joints and then validating it with independent test results conducted in a wide range of loading and environmental conditions. The tests were performed at speeds between 0.2 and 6000 mm/min and at three different temperatures ranging from -30 °C to 60 °C. Mode I fracture toughness was measured using the DCB (double cantilever beam) specimens. Using a simple triangular CZM may not be optimal for predicting the mechanical response of highly flexible adhesives with complex failure mechanisms and multiple crack paths. However, by correctly adjusting the cohesive zone properties for a limited set of reference conditions, it is possible to accurately predict the mechanical response of these joints across various test speeds and temperatures, significantly reducing costs and effort.

Left ventricular diastolic function assessed by speckle tracking echocardiography in patients with left ventricular aneurysm.

Speckle-tracking echocardiography (STE) parameters are an integral part of the assessment of left ventricular (LV) function. We aimed to evaluate established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm undergoing surgical ventricular repair (SVR). We retrospectively examined the data of 137 patients with anteroapical LV aneurysm who underwent SVR. In 27 patients, the correlation of STE parameters with invasive hemodynamic parameters was evaluated. Preoperative echocardiographic parameters were assessed for their association with outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. The late diastolic strain rate (GLSRa) showed a stronger correlation with mean pulmonary artery pressure (r = - 0.75, p < 0.001) than all other parameters. GLSRa was also significantly correlated with mean pulmonary capillary wedge pressure and LV end-diastolic pressure. In the multivariate model, GLSRa and the ratio of early diastolic filling velocity to GLSRa demonstrated incremental prognostic value in addition to clinical and echocardiographic parameters. Patients with GLSRa < 0.59 s-1 had significantly shorter event-free survival than those with GLSRa > 0.59 s-1 (6.7 vs. 10.9 years, p < 0.001). Peak reservoir left atrial strain showed a weaker association with hemodynamic parameters and outcome compared to GLSRa. In patients with LV aneurysm, late diastolic strain rate and left atrial strain can be used for the assessment of LV diastolic function and have a predictive value for the outcome after surgical ventricular restoration.

Experimental Investigation of Strain Rate Influence on Anisotropy of Uniaxial Tensile Mechanical Properties of CuFe2P Alloy Sheet.

Wire crimping, a process commonly used in the automotive industry, is a solderless method for establishing electrical and mechanical connections between wire strands and terminals. The complexity of predicting the final shape of a crimped terminal and the imperative to minimize production costs indicate the use of advanced numerical methods. Such an approach requires a reliable phenomenological elasto-plastic constitutive model in which material behavior during the forming process is described. Copper alloy sheets, known for their ductility and strength, are commonly selected as terminal materials. Generally, sheet metals exhibit significant anisotropy in mechanical properties, and this phenomenon has not been sufficiently investigated experimentally for copper alloy sheets. Furthermore, the wire crimping process is conducted at higher velocities; therefore, the influence of the strain rate on the terminal material behavior has to be known. In this paper, the influence of the strain rate on the anisotropic elasto-plastic behavior of the copper alloy sheet CuFe2P is experimentally investigated. Tensile tests with strain rates of 0.0002 s-1, 0.2 s-1, 1 s-1, and 5.65 s-1 were conducted on sheet specimens with orientations of 0°, 45°, and 90° to the rolling direction. The influence of the strain rate on the orientation dependences of the stress-strain curve, elastic modulus, tensile strength, elongation, and Lankford coefficient was determined. Furthermore, the breaking angle at fracture and the inelastic heat fraction were determined for each considered specimen orientation. The considered experimental data were obtained by capturing the loading process using infrared thermography and digital image correlation techniques.

High-throughput quantification of quasistatic, dynamic and spall strength of materials across 10 orders of strain rates.

The response of metals and their microstructures under extreme dynamic conditions can be markedly different from that under quasistatic conditions. Traditionally, high strain rates and shock stresses are achieved using cumbersome and expensive methods such as the Kolsky bar or large spall experiments. These methods are low throughput and do not facilitate high-fidelity microstructure-property linkages. In this work, we combine two powerful small-scale testing methods, custom nanoindentation, and laser-driven microflyer (LDMF) shock, to measure the dynamic and spall strength of metals. The nanoindentation system is configured to test samples from quasistatic to dynamic strain-rate regimes. The LDMF shock system can test samples through impact loading, triggering spall failure. The model material used for testing is magnesium alloys, which are lightweight, possess high-specific strengths, and have historically been challenging to design and strengthen due to their mechanical anisotropy. We adopt two distinct microstructures, solutionized (no precipitates) and peak-aged (with precipitates) to demonstrate interesting upticks in strain-rate sensitivity and evolution of dynamic strength. At high shock-loading rates, we unravel an interesting paradigm where the spall strength vs. strain rate of these materials converges, but the failure mechanisms are markedly different. Peak aging, considered to be a standard method to strengthen metallic alloys, causes catastrophic failure, faring much worse than solutionized alloys. Our high-throughput testing framework not only quantifies strength but also teases out unexplored failure mechanisms at extreme strain rates, providing valuable insights for the rapid design and improvement of materials for extreme environments.

Is CRT Optimization Obsolete? A Referral Center's Experience.

Background: Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure (HF). However, 30% of HF patients do not show any improvement in clinical status after CRT implantation. In this study, we report our echocardiography-based CRT optimization methodology, in daily practice at our CRT referral center. Methods: We included 350 ambulatory patients, who were referred to our center for optimization after CRT implantation. A protocol-driven echocardiographic approach for adjusting mechanical dyssynchrony, whereby adjusting for ventriculoventricular (VV) delays with strain and atrioventricular (AV) delays with Doppler echocardiography was performed. We defined changes in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) classes as outcome variables in the evaluation of the CRT outcomes. Results: Optimization was obtained in 288 (82%) patients. VV and AV timings were adjusted to 61% and 51%, respectively. In 3%, biventricular pacing was turned off and in 3% left ventricular (LV) only pacing was programmed. The LVEF and NYHA class showed significant improvements in all patients who underwent CRT optimization. Conclusions: CRT optimization remains valuable in improving LVEF and functional status measured using the NYHA class in all patients receiving CRT devices.

Pulse Design of Constant Strain Rate Loading in SHPB Based on Pulse Shaping Technique.

The Split Hopkinson pressure bar (SHPB) is widely used for characterizing the mechanical behavior of materials at high strain rates. One of the most challenging factors is achieving constant strain rate (CSR) loading of the specimen at a certain strain rate. Obtaining the effective incident pulse based on the experimental material for achieving CSR loading remains unresolved. This research focuses on obtaining the proper incident pulse for achieving constant strain rate loading using the pulse-shaping technique. A parameterized objective incident model in terms of the strain rate and quasi-static (or dynamic stress-strain) behavior of the material is established utilizing the three-wave method. Experimental pulses that closely resemble the desired objective pulses can be generated by adjusting parameters such as the geometry of the shaper, the shaper material, striker velocities, and the length of the striker according to the pulse-shaping model. The model is applied to the design of the incident pulse for B4CP/2024Al composite material, and the dynamic stress-strain curves at different strain rates are obtained under CSRs. This model provides effective guidance for selecting an appropriate shaper and achieving CSR loading in SHPB tests.

High-Strain-Rate Deformation Behavior of Co0.96Cr0.76Fe0.85Ni1.01Hf0.40 Eutectic High-Entropy Alloy at Room and Cryogenic Temperatures.

The deformation behaviors of Co0.96Cr0.76Fe0.85Ni1.01Hf0.40 eutectic high-entropy alloy (EHEA) under high strain rates have been investigated at both room temperature (RT, 298 K) and liquid nitrogen temperature (LNT, 77 K). The current Co0.96Cr0.76Fe0.85Ni1.01Hf0.40 EHEA exhibits a high yield strength of 740 MPa along with a high fracture strain of 35% under quasi-static loading. A remarkable positive strain rate effect can be observed, and its yield strength increased to 1060 MPa when the strain rate increased to 3000/s. Decreasing temperature will further enhance the yield strength significantly. The yield strength of this alloy at a strain rate of 3000/s increases to 1240 MPa under the LNT condition. Moreover, the current EHEA exhibits a notable increased strain-hardening ability with either an increasing strain rate or a decreasing temperature. Transmission electron microscopy (TEM) characterization uncovered that the dynamic plastic deformation of this EHEA at RT is dominated by dislocation slip. However, under severe conditions of high strain rate in conjunction with LNT, dislocation dissociation is promoted, resulting in a higher density of nanoscale deformation twins, stacking faults (SFs) as well as immobile Lomer-Cottrell (L-C) dislocation locks. These deformation twins, SFs and immobile dislocation locks function effectively as dislocation barriers, contributing notably to the elevated strain-hardening rate observed during dynamic deformation at LNT.

Effect of Strain Rate on Mechanical Deformation Behavior in CuZr Metallic Glass.

Tensile tests were performed on Cu64Zr36 metallic glass at strain rates of 107/s, 108/s, and 109/s via classical molecular dynamics simulations to explore the underlying mechanism by which strain rate affects deformation behavior. It was found that strain rate has a great impact on the deformation behavior of metallic glass. The higher the strain rate is, the larger the yield strength. We also found that the strain rate changes the atomic structure evolution during deformation, but that the difference in the atomic structure evolution induced by different strain rates is not significant. However, the mechanical response under deformation conditions is found to be significantly different with the change in strain rate. The average von Mises strain of a system in the case of 107/s is much larger than that of 109/s. In contrast, more atoms tend to participate in deformation with increasing strain rate, indicating that the strain localization degree is more significant in cases of lower strain rates. Therefore, increasing the strain rate reduces the degree of deformation heterogeneity, leading to an increase in yield strength. Further analysis shows that the structural features of atomic clusters faded out during deformation as the strain rate increased, benefiting more homogeneous deformation behavior. Our findings provide more useful insights into the deformation mechanisms of metallic glass.

Research on Macroscopic Mechanical Behavior of Recycled Aggregate Concrete Based on Mesoscale.

Recycled concrete is a heterogeneous composite material, and the composition and volume fraction of each phase affect its macroscopic properties. In this paper, ANSYS APDL was used to construct a two-dimensional numerical model of recycled aggregate concrete with different replacement rates of recycled aggregate (0%, 25%, 50%, 75% and 100%), and a uniaxial compression test was carried out to explore the relationship between recycled aggregate content and its macroscopic mechanical behavior. On this basis, the numerical simulation of different strain rates (0.1 s-1, 0.05 s-1, 0.01 s-1, 0.005 s-1 and 0.001 s-1) was carried out. It was found that with the increase in the recycled aggregate replacement rate, the peak stress decreases first and then increases, and the peak strain increases continuously. When the replacement rate of recycled aggregate exceeds 50%, the overall damage area of the material increases rapidly. The strain rate will change the path of the micro-crack initiation and expansion of recycled concrete, as well as the process of damage accumulation and evolution. As a result, the unit area and shape of recycled concrete are different at different strain rates, and the damage degree of each phase material is also different.

A Comprehensive Excursus of the Roles of Echocardiography in Heart Transplantation Follow-Up.

Current guidelines for the care of heart transplantation recipients recommend routine endomyocardial biopsy and invasive coronary angiography as the cornerstones in the surveillance for acute rejection (AR) and coronary allograft vasculopathy (CAV). Non-invasive tools, including coronary computed tomography angiography and cardiac magnetic resonance, have been introduced into guidelines without roles of their own as gold standards. These techniques also carry the risk of contrast-related kidney injury. There is a need to explore non-invasive approaches providing valuable information while minimizing risks and allowing their application independently of patient comorbidities. Echocardiographic examination can be performed at bedside, serially repeated, and does not carry the burden of contrast-related kidney injury and procedure-related risk. It provides comprehensive assessment of cardiac morphology and function. Advanced echocardiography techniques, including Doppler tissue imaging and strain imaging, may be sensitive tools for the detection of minor myocardial dysfunction, thus providing insight into early detection of AR and CAV. Stress echocardiography may offer a valuable tool in the detection of CAV, while the assessment of coronary flow reserve can unravel coronary microvascular impairment and add prognostic value to conventional stress echocardiography. The review highlights the role of Doppler echocardiography in heart transplantation follow-up, weighting advantages and limitations of the different techniques.