Key result
Multi-chamber strain echocardiography adds incremental diagnostic and prognostic value over conventional parameters in HFpEF.
Why the study?
HFpEF is heterogeneous with challenging early diagnosis and risk stratification, creating a need for sensitive imaging markers to detect early myocardial dysfunction and refine patient characterization.
Integrating multi-chamber strain echocardiography into routine evaluation enhances the early diagnosis, phenotyping, and risk stratification of patients with HFpEF beyond conventional imaging.
Supports multi-chamber strain for HFpEF phenotyping; extends LV-GLS data but leaves open prospective validation before routine use.
Heart failure with preserved ejection fraction (HFpEF) represents an increasingly prevalent clinical syndrome, driven by population ageing and the growing burden of cardiometabolic comorbidities, and is associated with significant morbidity and mortality. Due to its heterogeneous pathophysiology and the frequent absence of overt structural abnormalities, early diagnosis and accurate risk stratification remain challenging. In the current era of emerging disease-modifying therapies, the identification of sensitive imaging markers able to detect early myocardial dysfunction and refine patient characterization has become increasingly important. Speckle-tracking echocardiography has emerged as a valuable tool for the comprehensive evaluation of HFpEF, allowing the assessment of subclinical myocardial impairment beyond conventional parameters. Left ventricular global longitudinal strain (LV-GLS) identifies subtle systolic dysfunction despite preserved left ventricular ejection fraction (LVEF) and provides incremental diagnostic and prognostic information. Accordingly, LV-GLS has been incorporated into contemporary diagnostic algorithms and may represent a promising marker for monitoring disease progression and therapeutic response. Beyond the left ventricle (LV), left atrial (LA) strain has gained increasing relevance as a marker of atrial myopathy and elevated filling pressures. Left atrial reservoir strain (LARS) detects early atrial dysfunction before overt structural remodelling, improves the identification of HFpEF in patients with unexplained dyspnoea, and provides additional prognostic information, including prediction of atrial fibrillation and thromboembolic risk. Moreover, right ventricular free-wall longitudinal strain (RV-FWLS) allows early recognition of right ventricular involvement and has shown important prognostic implications, particularly in relation to pulmonary vascular dysfunction and exercise intolerance. Overall, a multi-chamber strain-based approach may improve HFpEF diagnosis, phenotyping, and risk stratification, supporting a transition toward a more personalized management strategy. Further prospective studies are needed to define the role of strain imaging in guiding therapeutic decisions and monitoring treatment response.
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Pastore et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Multi-chamber strain echocardiography vs. Conventional echocardiography was evaluated. Multi-chamber strain echocardiography, including LV-GLS, LA strain, and RV-FWLS, provides incremental diagnostic and prognostic value beyond conventional parameters in patients with HFpEF.
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