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The combination of left ventricular function, especially left ventricle ejection fraction (LVEF), with clinical characteristics has been successfully used for an extended period to guide therapeutic decisions in patients with heart failure (HF) and myocardial infarction, despite numerous approaches to identify better prognostic indices. In recent years, new echocardiographic modalities have been introduced that can identify and measure the motion, deformation and translation of the heart, as well as quantifying the functional properties of the myocardium. Speckle technology can precisely and independently use the angle of incidence to assess several parameters of myocardial function, including left ventricle mechanical dyssynchrony, left ventricle strain and left ventricle torsion. With the use of these new echocardiographic modalities (twist, rotation and deformation images), Toumanidis et al. report, in this issue of HJC, that left ventricular pacing at the apex, outside the ischemic area, displays a better response. These findings may be explained by the observation that pacing from this site leads to a more physiological propagation of electrical conduction and warrants further research in specific clinical situations and in patients with advanced ischemic heart failure. These new echocardiographic techniques can be used to assess the left ventricle and right ventricle function. On this specific topic, Maragiannis et al. summarize, in their review article, how these new imaging modalities can improve the assessment of the right ventricle and tricuspid valve function, especially for prosthetic tricuspid valves. Furthermore, they strongly recommend using a combined approach to functionally evaluate tricuspid prosthetic valveswith both Doppler parameters, which have been traditionally used, and newer three-dimensional imagingmodalities in a clinical meaningful algorithm because this approach may increase the accuracy and reproducibility of the results.

New modalities assessing left and right ventricular function: How they apply to myocardial infarction