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Review
. 2019 Nov;74(5):397-402.
doi: 10.1016/j.jjcc.2019.06.004. Epub 2019 Jul 12.

Use of speckle tracking to assess heart failure with preserved ejection fraction

John B Hiebert  1 , James Vacek  2 , Zubair Shah  3 , Faith Rahman  4 , Janet D Pierce  5
Affiliations
Review

Use of speckle tracking to assess heart failure with preserved ejection fraction

John B Hiebert et al. J Cardiol. 2019 Nov.

Abstract

Heart failure with preserved ejection fraction (HFpEF) currently represents approximately 50% of heart failure (HF) cases in the USA and is increasingly recognized as a leading cause of morbidity and mortality. Recent data suggest that the prevalence of HFpEF relative to HF with reduced ejection fraction (HFrEF) is increasing at a rate of 1% per year. With an aging population and increasing risk factors such as hypertension, obesity, and diabetes mellitus, HFpEF will soon be the most prevalent HF phenotype. Two-dimensional speckle-tracking echocardiography (STE) has been used to diagnose HFpEF specifically by focusing on the longitudinal systolic function of the left ventricle (LV). Yet there are many patients with HFpEF in whom there are no differences in LV global longitudinal systolic strain, but there are changes in left atrial function and structure. There are several proposed pathophysiological mechanisms for HFpEF such as endothelial dysfunction, interactions among proteins, signaling pathways, and myocardial bioenergetics. Yet only one specific therapy, mineralocorticoid receptor antagonist, spironolactone, is recommended as a treatment for patients with HFpEF. However, spironolactone does not address many of the pathophysiologic changes that occur in HFpEF, thus new novel therapeutic agents are needed. With the limited available therapies, clinicians should use STE to assess for the presence of this syndrome in their patients to provide effective diagnosis and management.

Keywords: Diagnostic testing; Heart failure with preserved ejection fraction; Speckle tracking.

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Conflict of interest statement

Conflict of Interest

There is no conflict of interest for any of the authors to declare.

Figures

Figure 1
Figure 1
In heart failure with preserved ejection fraction there is microvascular inflammation that activates the endothelial to begin a cascade of adverse effects that leads to left ventricular dysfunction. ATP, adenosine triphosphate; cGMP, cyclic guanosine monophosphate; LV, left ventricular.
Figure 2
Figure 2
An illustration of how the left ventricle rotates during systole and diastole.
See this image and copyright information in PMC

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