Tavernese Annamaria, Rizza Vincenzo, Cammalleri Valeria, Mollace Rocco, Carresi Cristina, Antonelli Giorgio, Cocco Nino, D'Antonio Luca, Gelfusa Martina, Piccirillo Francesco, Nusca Annunziata, Ussia Gian Paolo
Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy.
Hemodynamic Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy.
J Cardiovasc Dev Dis. 2025 Jun 16;12(6):229. doi: 10.3390/jcdd12060229.
Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure-strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation.
射血分数保留的心力衰竭（HFpEF）占所有心力衰竭病例的近一半，由于其病理生理异质性和常为细微的心肌功能障碍，在诊断上仍具有挑战性。传统超声心动图参数，如左心室射血分数（LVEF）和左心房容积指数（LAVI），常常无法检测到早期功能变化。先进的超声心动图技术已成为早期诊断和风险分层的重要工具。整体纵向应变（GLS）即使在LVEF保留的情况下也能识别亚临床收缩功能障碍。左心房应变（LAS），特别是储存器和泵应变，可提供舒张功能和充盈压升高的敏感标志物，为诊断和预后提供更多信息。心肌做功（MW）通过无创压力-应变环，能够独立于负荷评估心肌收缩力，而右心室游离壁纵向应变（RVFWLS）可发现早期右心受累情况，这在晚期HFpEF中常存在。整合这些先进参数可提高诊断准确性并指导个性化治疗策略。本综述强调了基于应变的成像在HFpEF中的现有证据和临床应用，强调了多参数、以病理生理学为导向的方法在心力衰竭评估中的重要性。
