Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome with increasing prevalence. Patients with HFpEF experience similar patterns of morbidity and functional decline as do those with heart failure and reduced ejection fraction, but effective treatments for HFpEF are lacking. The pathophysiology of HFpEF is complex and the major gaps are still present today in our understanding of HFpEF pathophysiology and managing patients. Recent studies revealed that left atrial (LA) dysfunction may be an important player in the pathophysiology of HFpEF. LA function assessed with the novel technique of 2D speckle tracking echocardiography (2D-STE) is able to provide critical information about the status of cardiac function, therefore could be used as a marker for the severity of HFpEF. LA dysfunction may represent a potential therapeutic target for patients with HFpEF.
Heart Failure; HFpEF; Left VentricularEjection Fraction
Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex syndrome characterized by heart failure symptoms and signs, but normal or near-normal left ventricular ejection fraction (LV-EF) . Epidemiological studies indicated that the prevalence of HFpEF within the population varies from 1.14% to 5.5%, and appears to be rising [1-4]. At least one-half of patients with HF indeed have preserved ejection fraction, and it is more likely seen in women, the elderly, people with a history of hypertension, obesity, and other cardiovascular risk factors [2,4 and 5]. Patients with HFpEF experience similar patterns of morbidity and functional decline as do those with heart failure and reduced ejection fraction (HFrEF) [4,5], but different from HFrEF which has classes of drugs to improve patients’ symptoms and outcome, the effective treatments for HFpEF are lacking [5,6]. One of the reasons is thought to be due to incomplete understanding of its pathophysiology therefore poor matching of therapeutic mechanisms and primary pathophysiological processes.
The diagnosis, classification of its severity, and management of HFpEF remain challenging due to the complicated pathophysiological processes, phenotypic manifestations, and frequent multiple concomitant illnesses [4,7]. In the clinical setting, echocardiography plays a key role in the evaluation and management of HFpEF. However, currently used techniques, 2D and Doppler echocardiography have shown several limitations [7,8]. 2D speckle tracking echocardiography (2D-STE) is a novel technique that has been shown a feasible and sensitive method for evaluating the LA deformation in patients with HFpEF. In this review, we will address the potential role of left atrial dysfunction assessed with 2D-STE in the diagnosis and clarification of the severity in patients with HFpEF according to our study and existing literature.