The Role of Endoscopic Ultrasound in Cardiology: Clinical Applications and Future Perspectives, a New Era of Minimally Invasive Cardiovascular Diagnosis and Intervention

Background: Ultrasonography during medical procedures allows for real-time assessment of the target structure. This design feature could be more advantageous than radiological “snapshot” imaging. Technically, the image resolution of endoscopic ultrasound (EUS) is noticeably higher than that of transesophageal echocardiography (TOE). The benefits of investigating cardiovascular structures using this mode of high-resolution EUS are unknown. Materials and Methods: We present clinical applications in the diagnosis of cardiovascular structures, demonstrated during routine gastrointestinal endosonographic procedures. In some cases, these diagnoses led to changes in management strategies. Results and Discussion: The introduction of high-resolution EUS into cardiology allows for the accurate definition of variable cardiovascular anatomy and early detection of asymptomatic cardiac pathologies. It also prevents double investigations for patients and operators, reduces the risk of esophageal trauma, and highlights the benefits of interdisciplinary teamwork. In addition, the high spatial resolution of EUS facilitates detailed tissue characterization for guiding biopsies, thereby extending the applicability of elastography across various echocardiographic domains. Moreover, the precision of using EUS when targeting and inserting a needle into adjacent organs could facilitate the development of EUS indications for cardiac-based interventions. Conclusions: The use of EUS in cardiology provides high-resolution real-time assessments of cardiovascular anatomy and may facilitate the development of EUS indications for cardiac-based interventions. However, large cohort studies are required.