Approach to Echocardiography in Heart Failure with Preserved Ejection Fraction

As echocardiography is universally performed in the evaluation of suspected heart failure with preserved ejection fraction (HFpEF), a number of structural and functional characteristics relevant to both the diagnosis and phenotyping of HFpEF can be elucidated. Exclusion of alternate causes of heart failure is a critical first step performed principally by echocardiography. Once HFpEF is confirmed, echocardiography may provide insight into pathophysiology and phenotyping by quantifying atrial mechanics, pericardial restraint, degree of pulmonary hypertension, and atrial valvular regurgitation. Although current echo-Doppler assessment of filling pressures is insensitive to diagnose HFpEF, there are emerging technologies such as left atrial (LA) strain that hold promise for noninvasive diagnosis.