Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex
clinical entity associated with significant morbidity and mortality.
Common comorbidities including hypertension, coronary artery disease,
diabetes, chronic kidney disease, obesity, and increasing age predispose
to preclinical diastolic dysfunction that often progresses to frank
HFpEF. That said, clinical HFpEF is typically associated with some
degree of diastolic dysfunction or can occur in the absence of many
conventional diastolic dysfunction indices. The exact biologic links
between risk factors, structural changes, and clinical manifestations
are not clearly apparent. Innovative approaches including deformation
imaging have enabled deeper understanding of HFpEF cardiac mechanics
beyond conventional metrics. Furthermore, predictive analytics through
data driven platforms have allowed for a deeper understanding of HFpEF
phenotypes. This review focuses on the changes in cardiac mechanics that
occur through preclinical myocardial dysfunction to clinically apparent
HFpEF.