Usefulness of handheld echocardiography for cardiovascular diseases in preventive cardiology

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, and current risk scores based on personal history, physical examination and basic tests fail to identify a proportion of individuals who will experience cardiovascular events. In this context, handheld echocardiography (HHE) is an intermediate step between clinical assessment alone and comprehensive transthoracic echocardiography, with the potential to act as an imaging-based tool within cardiovascular prevention programmes. Through focused, bedside or outpatient examinations, HHE can detect early signs of hypertensive organ damage as well as left and right ventricular dysfunction and other structural cardiovascular abnormalities, beyond traditional clinical evaluation. Through an examination of current evidence, technological developments, and clinical implementation pathways, this review provides a comprehensive overview of the evolving role of HHE as an adjunct to standard cardiovascular assessment, highlighting its potential to enhance early risk stratification in preventive cardiology. In this context, it proposes a pragmatic worklist for focused HHE examinations in at-risk individuals and illustrates representative HHE use cases, with involvement of non-cardiologists and the potential contribution of teleconsultation and digital integration. Finally, unresolved challenges are highlighted, defining the research priorities for the systematic integration of HHE into cardiovascular prevention strategies.