A significant update with a focus on left ventricular diastolic evaluation: • Analytic engine and Quick Entry (diastology) view extensively revised for evaluation of left ventricular diastolic function using the 2025 guidelines from the American Society of Echocardiography (ASE), with separate analyses for “special populations” (atrial fibrillation, heart transplant, left ventricular assist device (LVAD), mitral annular calcification (MAC), and noncardiac pulmonary hypertension). • Diastolic evaluation of hypertrophic cardiomyopathy revised to use the 2022 multimodality imaging guidelines from the ASE, American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography. • Diastolic Stress Echocardiography view updated to use the 2025 ASE diastolic evaluation guidelines. • Normal values adjusted for left atrial reservoir strain, left ventricular global longitudinal strain, and right ventricular free wall strain to conform to the 2025 guidelines from the ASE and the European Association of Cardiovascular Imaging. • Demographics and Clinical Conditions view updated to include special populations for diastolic evaluation. EchoLab is optimized for Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

A significant update with a focus on the right heart and pulmonary hypertension: • Analytic engine extensively revised for evaluation of pulmonary hypertension using the 2022 guidelines from the European Society of Cardiology and the European Respiratory Society (ESC/ERS). With this revision, EchoLab now uses the tricuspid regurgitant velocity as the primary variable for initial assessment of pulmonary hypertension instead of the calculated mean pulmonary artery pressure. • New Pulmonary Artery Systolic Pressure (TR velocity) view incorporates 2022 ESC/ERS guideline parameters to predict the probability of pulmonary hypertension as low, intermediate, or high. • Calculations of pulmonary artery systolic pressure from the tricuspid regurgitant velocity and from the gradient across a ventricular septal defect now are separated into two different views in the Pulmonary Artery category. • Quick Entry (pulmonary hypertension) view updated for a comprehensive evaluation of pulmonary hypertension with focused data entry. • New Left Ventricular Eccentricity Index view added for quantitative assessment of septal flattening in the presence of right ventricular pressure and/or volume overload. • Normal cutoff values for right atrial volume index, TAPSE, right ventricular base and mid-cavity width, right ventricular fractional area change, right ventricular free wall thickness, right ventricular free wall strain, and right ventricular index of myocardial performance adjusted to conform to the 2025 right heart guidelines from the American Society of Echocardiography (ASE). • Pulmonary vascular resistance calculation modified to follow the 2025 ASE right heart guidelines. • Main pulmonary artery width added as an enterable measurement in the Pulmonary Artery category and in the new Vessels category. • Aortic Root evaluation moved to the new Vessels category. • Right Atrial Volume view revised for right atrial volume index calculation using the area-length method, disc summation method, or direct 3D measurement. EchoLab is optimized for Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• New calculation added for estimation of the pulmonary capillary wedge pressure (PCWP) from the left atrial volume index, the mitral inflow E-wave velocity, and the pulmonary venous systolic velocity. • Hemodynamics view updated to include PCWP estimated with 3 different methods. • Enhanced evaluation of shock states in the Analytic Engine (cardiogenic, distributive, and hypovolemic shock), using the cardiac index, PCWP, and systemic vascular resistance. • Continued refinement of the Analytic Engine. EchoLab is optimized for Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to frequently used echocardiographic measurements under the Favorites tab. Consider making the Demographics and Clinical Conditions view into a favorite to ensure that the Analytic Engine accounts for relevant clinical factors. Check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

Several new calculations and analyses: • Left ventricular wall motion score index added to “Left Ventricle” category, along with semi-quantitative calculation of the left ventricular ejection fraction. Toggle switch shows typical coronary artery perfusion for each left ventricular wall segment. • Biventricular coupling index added to “Pulmonary Artery” category for helping to distinguish precapillary from postcapillary pulmonary hypertension. • Left atrial appendage emptying velocity added to “Atria” category for prediction of atrial fibrillation after cryptogenic stroke. Additional new features: • Demographics and Clinical Conditions view modified to include a toggle switch for atrial fibrillation, enhancing assessment by the Analytic Engine when this rhythm is present. Consider making this view one of your favorites for easy access, since once the patient’s sex is designated here, it no longer is necessary to specify the sex when utilizing the Analytic Engine. • Right atrial pressure view modified to permit 3 different ways to enter mean right atrial pressure. • Many refinements of the Analytic Engine. • Updated list of echocardiography and cardiology organizations. expanded to 79 direct links, found under “Organizations” using the “?” button at the top right of the opening app screen. EchoLab is optimized for Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

An extensive update with a focus on left atrial function: • New calculations and analyses for left atrial emptying fraction, left atrial expansion index, left atrial function index, and left atrial reservoir strain. • New calculation of pulmonary capillary wedge pressure (PCWP) from the left atrial expansion index. • Left Atrial Volume and Function view modified for entry of maximum and minimum left atrial volumes. • Analytic Engine updated to assess risk of developing atrial fibrillation, based on echocardiographic parameters. Additional new features: • New Demographics and Clinical Conditions view added to allow rapid baseline data entry and designation of conditions affecting data analysis (such as presence of a valve prosthesis). Consider making this view one of your favorites for easy access, since once the patient’s sex is designated here, it no longer is necessary to specify the sex when utilizing the Analytic Engine. • Right ventricular free wall strain added to right ventricular assessment. • Strain Imaging added as a new view category for data entry. • Multiple refinements of the Analytic Engine, including enhanced assessment of hypertrophic cardiomyopathy. • List of echocardiography and cardiology organizations expanded to over 70 direct links, found under “Organizations” using the “?” button at the top right of the initial app screen. EchoLab is optimized for Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• Minor update to expand display for height and weight to 2 decimal places, along with expanded decimal used internally for conversion of pounds to kilograms. New to EchoLab version 9.0: • All literature references, provided for each calculation, now include hyperlinks for direct internet access. • Literature references updated to include the latest societal guidelines. • New Aortic Valvulo-Arterial Impedance view added to the Aortic Valve section as an additional parameter for assessing aortic stenosis. • New Right Ventricular-Arterial Coupling view added to the Right Ventricle section as an additional parameter for assessing right ventricular contractile reserve in the presence of pulmonary hypertension. • Links to cardiology and echocardiography organizations updated in the Guides and Resources section. EchoLab is optimized for iOS 15 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• All literature references in the app, provided for each calculation, now include hyperlinks for direct internet access. • Literature references updated to include the latest societal guidelines. • New Aortic Valvulo-Arterial Impedance view added to the Aortic Valve section as an additional parameter for assessing aortic stenosis. • New Right Ventricular-Arterial Coupling view added to the Right Ventricle section as an additional parameter for assessing right ventricular contractile reserve in the presence of pulmonary hypertension. • Links to cardiology and echocardiography organizations updated in the Guides and Resources section. EchoLab is optimized for iOS 15 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• New Constrictive Pericarditis versus Restrictive Cardiomyopathy view integrates this portion of the 2016 ASE/EACVI diastology guidelines into the Analytic Engine. An Ancillary Findings button appears for entry of additional data if restrictive physiology is possible. • Deprecated 2009 ASE diastology assessment removed as an option from the Analytic Engine, which now exclusively uses the 2016 ASE/EACVI diastology guidelines in the Quick Entry (diastology) view. • Quick Entry (diastology) view now includes: • Entry of mitral inflow L-wave velocity, which, if abnormal, suggests a pseudonormal diastolic filling pattern. • Toggle switch to signify the presence of left bundle branch block or ventricular pacing, which, if present, may affect the diastolic assessment. • Button for direct access to the new Constrictive Pericarditis versus Restrictive Cardiomyopathy view. EchoLab is optimized for iOS 14 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• New Exercise Stress Echocardiography (ESE) view permits calculation and analysis from echocardiographic measurements obtained at peak exercise for assessment of non-ischemic heart disease. You can open the ESE view directly from the new Stress Echocardiography category, or with the “Exercise stress” button in the following views: • Cardiac Output (Teichholz) • Mitral ERO Area (PISA) • Quick Entry (aortic regurgitation) • Quick Entry (aortic stenosis) • Quick Entry (left heart) • Quick Entry (mitral regurgitation) • Quick Entry (mitral stenosis) • Quick Entry (pulmonary hypertension) • Quick Entry (right heart) • Quick Entry (standard) The ESE view has numerous possible data entries in the top half and calculation results in the bottom half. As a helpful guide, relevant fields are highlighted if the ESE view is opened using the “Exercise stress” button in one of the views above. For example, if you first go to Quick Entry (mitral regurgitation) and then use the “Exercise stress” button to open the ESE view, then all of the input and output fields in the ESE view relevant to the evaluation of mitral regurgitation at peak exercise are highlighted. Relevant input fields have a thick white or green border (depending on whether there is active data), and relevant output fields have a yellow border. As in all views in EchoLab, the “Analyze” button at the bottom left generates an analysis that integrates data from all views, including the ESE view. • New Diastolic Stress Echocardiography view added to the Left Ventricle and Stress Echocardiography categories, with peak-exercise diastolic Doppler measurements provided for the Analytic Engine. • echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) view in the Pulmonary Artery category enhanced with a clarified assessment statement and with a link to the pulmonary artery mean pressure calculation. • Aortic transvalvular flow rate added to the set of calculations in Aortic Valve Area (VTI) and to the Analytic Engine as an additional parameter for evaluation of aortic stenosis. • Left Atrial Volume calculation and Quick Entry views with left atrial measurement entry updated to allow a choice of area-length, disk summation, and 3D methods to use in the Analytic Engine. • Separate “Left Ventricular Diastology” section added to output from the Analytic Engine. • Quick Entry (basic) view re-named as Quick Entry (standard), containing all of the measurements in a standard transthoracic echocardiogram. • Bundled EchoLab app for the Apple Watch enhanced with new sections for exercise stress and diastolic stress echocardiography. • “Organizations” section of the EchoLab in-app Guide expanded to include links to 30 echocardiography-related entities worldwide. • Listed reference ranges for left ventricular mass index corrected to show linear measurement ranges, not 2D measurement ranges (Analytic Engine has been using linear ranges for assessment of left ventricular mass, as intended). • Deprecated 2014/2017 ACC/AHA guidelines for valvular heart disease removed from the Analytic Engine. EchoLab is optimized for iOS 14 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) added to the Pulmonary Artery category as a new calculation, providing an assessment of the transpulmonary gradient in the presence of pulmonary hypertension. • Analytic Engine enhanced to provide assessment of pulmonary hypertension as precapillary or postcapillary, utilizing ePLAR, pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance. • Upper limit of normal for PCWP and for left atrial pressure changed from 12 mmHg to 15 mmHg to conform to definitions of precapillary and postcapillary pulmonary hypertension. • Diastolic evaluation using ASE/EACVI 2016 guidelines updated to include algorithm for hypertrophic cardiomyopathy (HCM), activated with an “HCM” switch in the Quick Entry (diastology, 2016) view. • Sequence of toolbar buttons in each calculation view restored to prior arrangement (Analyze at the bottom left, Favorite in the middle, and Clear at the bottom right). EchoLab is optimized for iOS 13 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab. Remember also to check out the bundled Apple Watch app for EchoLab, providing a ready reference when performing echocardiograms.

• Bug fix update to restore consistent responsiveness of the Clear button at the bottom each calculation view. Correction involved changing the order of the Analyze, Clear, and Favorite buttons in the calculation toolbar. Version 7.1: • Analytic Engine enhanced to provide assessment of: -Hypertrophic cardiomyopathy. -Pulmonary embolism with the “60/60” sign (pulmonary artery acceleration time ≤ 60 msec, and tricuspid regurgitant gradient > 30 mmHg and ≤ 60 mmHg). • Streamlined diastolic evaluation by the Analytic Engine using ASE/EACVI 2016 guidelines, with a correction to use pulmonary venous systolic/diastolic flow ratio only with a depressed left ventricular ejection fraction. • Aortic valve area by planimetry added to Aortic Valve category, and mitral valve area by planimetry added to Mitral Valve category, for enhanced evaluation of valve stenosis by the Analytic Engine. EchoLab is optimized for iOS 13 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room.

• Analytic Engine enhanced to provide assessment of: -Hypertrophic cardiomyopathy. -Pulmonary embolism with the “60/60” sign (pulmonary artery acceleration time ≤ 60 msec, and tricuspid regurgitant gradient > 30 mmHg and ≤ 60 mmHg). • Streamlined diastolic evaluation by the Analytic Engine using ASE/EACVI 2016 guidelines, with a correction to use pulmonary venous systolic/diastolic flow ratio only with a depressed left ventricular ejection fraction. • Aortic valve area by planimetry added to Aortic Valve category, and mitral valve area by planimetry added to Mitral Valve category, for enhanced evaluation of valve stenosis by the Analytic Engine. EchoLab is optimized for iOS 13 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room.

A major update for EchoLab and the companion app for the Apple Watch! • EchoLab now is optimized for iOS 13 with Dark Mode, ideal for use in the dimmed lighting of a typical echocardiography reading room. • Analytic Engine enhanced to provide assessment of: - Aortic regurgitant jet width and area - Left ventricular cavity size and wall thickness - Left ventricular ejection fraction (from 3D imaging) - Left ventricular stroke volume index Look for “Aortic Regurgitant Jet Width and Cross-Sectional Area” in the Aortic Valve category. Look for “Left Ventricular Ejection Fraction (3D Imaging)” in the Left Ventricle category. • “Quick Entry (aortic regurgitation)” and “Quick Entry (mitral regurgitation)” added to the Quick Entry category to permit rapid entry of associated measurements. Remember that designating Quick Entry views as favorites permits easy access to the most frequently used echocardiographic measurements under the Favorites tab.

• A minor update with interface enhancements. New features in EchoLab version 6.4: • Aortic Prosthetic Paravalvular Regurgitant Extent and Aortic Regurgitant Pressure Half-time added to aortic valve evaluation (located in the Aortic Valve collection). • Right Ventricular Fractional Area Change calculation re-labeled as “Right Ventricular Measurements” with the addition of several variables, all incorporated into the Analytic Engine: - Right ventricular diameter (base) - Right ventricular diameter (mid-cavity) - Right ventricular free wall thickness • EchoLab companion app for the Apple Watch updated to include new aortic valve and right ventricular measurements. • Continued enhancement of the Analytic Engine algorithm.

• Aortic Prosthetic Paravalvular Regurgitant Extent and Aortic Regurgitant Pressure Half-time added to aortic valve evaluation (located in the Aortic Valve collection). • Right Ventricular Fractional Area Change calculation re-labeled as “Right Ventricular Measurements” with the addition of several variables, all incorporated into the Analytic Engine: - Right ventricular diameter (base) - Right ventricular diameter (mid-cavity) - Right ventricular free wall thickness • EchoLab companion app for the Apple Watch updated to include new aortic valve and right ventricular measurements. • Continued enhancement of the Analytic Engine algorithm.

• New Quick Entry view added for evaluation of mitral stenosis, placing commonly used variables on a single screen. Look for Quick Entry (mitral stenosis) in the Quick Entry collection and make it a favorite for convenient access. • Toggle for prosthetic mitral valve added to: - Mitral Valve Area (continuity) - Quick Entry (mitral stenosis) With the prosthetic mitral valve toggle in the ON position, the Analytic Engine interprets mitral valve data according to the 2009 prosthetic valve guidelines from the American Society of Echocardiography. • Global longitudinal strain (GLS) added to left ventricular evaluation (located in the Left Ventricle collection), and incorporated into the Analytic Engine. • EchoLab companion app for the Apple Watch updated to include quick references for prosthetic mitral valve evaluation and GLS. • Exported analysis from the Analytic Engine now includes an appended list of all calculated variables, organized by section (left ventricle, right ventricle, atria, etc.). • Enhanced Analytic Engine algorithm.

• Diastolic evaluation updated with the 2016 guidelines from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. - Access the 2016 guidelines with the new Quick Entry (diastology, 2016) analysis item. - Access the 2009 diastology guidelines with the Diastolic Evaluation (2009) and the Quick Entry (diastology, 2009) analysis items. By default the Analytic Engine uses the 2016 diastology guidelines, but you can choose a default in the EchoLab app Settings. • Diastolic evaluation reference added to the companion EchoLab app for the Apple Watch. • Color “complication” added to support the Apple Watch Series 4.

• Toggle for prosthetic aortic valve analysis added to: - Aortic Flow Acceleration Time - Aortic Valve Area (velocity) - Aortic Valve Area (VTI) - Quick Entry (aortic stenosis) With the prosthetic aortic valve toggle in the ON position, the Analytic Engine interprets aortic valve data according to the guidelines from the American Society of Echocardiography. • Additional refinements incorporated into the Analytic Engine for assessment of native aortic valve stenosis. • Prosthetic aortic valve evaluation reference added to the companion EchoLab app for the Apple Watch.

New Apple Watch companion app for use as a quick reference when performing or interpreting echocardiograms. For each calculation: • See what measurements are needed. • Check reference ranges. • Read notes about obtaining measurements and using the calculation. • View a schematic of the formula. Support added for iPhone X screen size. New calculations and analyses for the Analytic Engine: • Projected aortic valve area, added to the Aortic Valve Area (dobutamine) calculation, accessible also from the Quick Entry (aortic stenosis) view. • Aortic flow acceleration time and ratio to left ventricular ejection time for evaluation of aortic stenosis, added to the Aortic Valve category. Multiple enhancements of the Analytic Engine. Complete revision of the application guide for improved access to all of EchoLab’s content and features. Bug fix for download of guideline documents and scientific papers with the "My Library" import function.

• Minor update with small, but important bug fix to ensure that “Active Data” notification always is set properly while calculation and analysis are in progress.

• New calculation: left ventricular stroke work loss added to assessment of aortic stenosis. • Bug fix to prevent app from quitting if trying to access reference information for certain calculations.

• Minor changes for compatibility with iOS 11 software update.

A major update with many new features! • Greatly enhanced Analytic Engine, now generating a concise summary at the end of each analysis, no matter how complex. Scroll to the bottom of each analysis to see the summary. • Reference values added to the Reference section for each echocardiographic calculation or assessment. • Comprehensive list of reference values accessible now with the Information button at the top right of each list of calculations. • New option in Settings (on by default) includes or excludes select reference ranges from Analytic Engine text output (such as reference ranges for left ventricular ejection fraction). • Assessments added for size of pericardial effusion and for flow velocity paradoxus, along with incorporation of these pericardial findings into the Analytic Engine. • Measurement of left ventricular outflow tract automatically assessed for possible error (too large or too small) if body surface area also entered.

• Minor update to correct the reference values used by the Analytic Engine to assess the severity of left ventricular hypertrophy (changing reference values from 2D method to linear method for left ventricular mass calculation).

• Modification of aortic regurgitation index calculation for transcatheter aortic valve replacement (TAVR) to include Pre-TAVR and Post-TAVR indices, with corresponding enhancement of the Analytic Engine. • Formatting changes to support both iOS 9 and iOS 10.