Ultrasound Findings with Bedside Ultrasound of Heart Failure with Preserved LVEF

Heart failure with preserved ejection fraction (HFpEF), formerly termed diastolic heart failure, constitutes nearly half the heart failure cases. Patients may exhibit acute heart failure symptoms, yet bedside echocardiograms might indicate normal left ventricular systolic function, potentially leading to the premature exclusion of heart failure as a differential diagnosis. This review delves into fundamental echocardiographic principles associated with diastolic dysfunction, crucial for recognition in HFpEF patients. Specifically, it explores the VALVE protocol, a stepwise approach tailored for the exigent nature of emergency departments. Acquiring accurate imaging windows in acutely ill patients poses a challenge, emphasizing the significance of precise measurements to avoid errors. Techniques such as E-point septal separation (EPSS) must be meticulously positioned for ejection fraction determinations. The discussion focuses on key metrics outlined in the VALVE protocol, encompassing ventricular function, annular tissue Doppler imaging (TDI) measurements, left atrium volume, mitral valve velocities, and the E/e0 ratio as indicators of diastolic dysfunction in HFpEF.