Heart Failure With Preserved Ejection Fraction　― Time for a Paradigm Shift Beyond Diastolic Function ―

Figures

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  Figure 1.. Progressive changes in inappropriate left atrial (LA)-left ventricular (LV)-arterial coupling as a pathway from healthy stage to heart failure with preserved ejection fraction (HFpEF). AF, atrial fibrillation; E/A, ratio of peak early diastolic to atrial systolic velocity of transmitral flow; E/e’, ratio of peak early diastolic transmitral flow to mitral annular motion velocity; LAP, LA pressure; LVEDP, left ventricular end-diastolic pressure; PVP, pulmonary venous pressure; S-LAs, peak LA strain during ventricular systole; S-LVs, peak LV strain during ejection phase; SR-LAs, peak LA strain rate during ventricular systole; SR-LVe, peak LV strain rate during isovolumic diastole; SR-LVs, peak LV strain rate during isovolumic systole.

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  Figure 2.. Left ventricular (LV) (Left) strain and (Right) strain rate curves obtained from 2-D speckle-tracking echocardiography in a healthy individual (25 years old). 4ch, 4-chamber view; S-LVs, peak LV strain during ejection phase; SAX, short-axis view; SR-LVa, peak LV strain rate during atrial systole; SR-LVe, peak LV strain rate during isovolumic diastole; SR-LVs, peak LV strain rate during isovolumic systole.

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  Figure 3.. Left atrial (LA; Top) strain and (Bottom) strain rate curves obtained from 2-D speckle-tracking echocardiography in (Left) a healthy individual (22 years old) and (Right) an asymptomatic stage B patient (60 years old) with cardiovascular risk factors. LA reservoir function (S-LAs and SR-LAs) is significantly lower in the (Right) asymptomatic stage B patient (19.9% and 0.80 s−1, respectively) compared with the healthy individual (39.9% and 1.65 s−1, respectively). S-LAa, peak LA strain during atrial systole; S-LAe, peak LA strain during early ventricular diastole; S-LAs, peak LA strain during ventricular systole; SR-LAa, peak LA strain rate during atrial systole; SR-LAe, peak LA strain rate during early ventricular diastole; SR-LAs, peak LA strain rate during ventricular systole. (Reproduced with permission from Oishi Y, et al.34)

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  Figure 4.. Representative abdominal aortic peak circumferential strain (AAO-S) patterns obtained from 2-D speckle-tracking echocardiography in (Top) a healthy individual (20 years old) and (Bottom) an asymptomatic stage B patient (65 years old) with cardiovascular risk factors. The AAO-S is markedly lower in the patient (2.5%) compared with the healthy subject (15.1%).