Heart Failure With Preserved Ejection Fraction　- Time for a Paradigm Shift Beyond Diastolic Function.

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Heart failure with preserved ejection fraction (HFpEF) is prevalent and associated with aging and multiple comorbidities.
• Pathophysiology involves impaired left ventricular (LV) relaxation and increased LV-arterial stiffness, affecting diastolic and systolic function.
• Current diagnostic methods may not detect early functional abnormalities.

Purpose of the Study:

• To review the role of 2-D speckle-tracking echocardiography (2D-STE) in the early detection of cardiac and vascular abnormalities in HFpEF.
• To highlight 2D-STE's potential in identifying impairments in left atrial (LA)-LV-arterial coupling.
• To emphasize the utility of 2D-STE for earlier pathophysiology insights and prevention strategies for HFpEF.

Main Methods:

• Utilizing non-invasive echocardiographic techniques, including 2-D, flow velocity Doppler, and tissue Doppler echocardiography.
• Applying 2-D speckle-tracking echocardiography (2D-STE) for detailed assessment of LA, LV, and elastic artery function.
• Evaluating parameters related to LV filling pressure and afterload mismatch.

Main Results:

• 2D-STE is feasible for assessing functional abnormalities in asymptomatic individuals with cardiovascular risk factors (Stages A, B).
• 2D-STE can detect impairments in LA-LV and LV-arterial coupling beyond traditional diastolic function assessments.
• Early detection of these coupling abnormalities may precede overt HFpEF symptoms.

Conclusions:

• 2D-STE offers a valuable tool for the early diagnosis of HFpEF pathophysiology.
• Identifying LA-LV-arterial coupling impairments with 2D-STE can inform prevention strategies.
• This technique may improve understanding and management of HFpEF.