Echo-Based Approach to the Management of Heart Failure With Preserved Ejection Fraction

Diastolic dysfunction is a central derangement found in heart failure, regardless of ejection fraction (EF). Although EF may be preserved, subtle systolic dysfunction is often present in heart failure with preserved ejection fraction (HFpEF) as evidenced by deformation imaging. Systemic inflammation and metabolic changes also contribute to the HFpEF syndrome. In addition to impairment in left ventricular (LV) properties, those with HFpEF may suffer from a multitude of associated conditions, including right heart dysfunction, pulmonary hypertension, ventricular-arterial uncoupling, left atrial dysfunction, chronotropic incompetence, atrial tachyarrhythmias, and maladaptive peripheral vascular and skeletal abnormalities. Complementary to the diastolic LV assessment, evaluation of several of these associated conditions makes echocardiography an essential tool in the management of HFpEF.