Introduction
Heart Failure with preserved ejection fraction (HFpEF) is a complex
clinical entity associated with significant morbidity and mortality.
HFpEF is responsible for approximately half of all heart failure
hospitalizations, with mean survival similar to those with heart failure
with reduced ejection fraction1. HFpEF typically
begins with risk factor exposure, which promotes abnormal cardiac
mechanics and preclinical myocardial dysfunction. Preclinical diastolic
dysfunction is present in approximately ΒΌ of the adult population2. A significant proportion of patients with diastolic
dysfunction go on to develop frank clinical heart failure.
The exact biologic links responsible for diastolic dysfunction and heart
failure are not clearly apparent, but can be attributed to a complex
interplay of various pathological conditions on background
aging3. Until recently, myocardial determinants of
HFpEF were thought primarily related to impairments in left ventricular
relaxation and chamber stiffness. However, contemporary studies
recognize the contribution of subtle left and right ventricular systolic
dysfunction, as well as the impact of left atrial function and
pericardial compliance. Furthermore, myocardial dysfunction may
initially occur only during exercise and the static resting evaluation
may not fully characterize potential dynamic changes. Therefore,
assessment of cardiac mechanics during rest and exercise plays an
important role in diagnosis and prognostication 4.
This review focuses on the changes in cardiac mechanics that occur
through the spectrum of preclinical myocardial dysfunction into
clinically apparent HFpEF.