Research in the last decade has substantially advanced our understanding of the pathophysiology of heart failure with preserved ejection fraction (HFpEF). However, treatment options remain limited as clinical trials have largely failed to identify effective therapies. Part of this failure may be related to mechanistic heterogeneity. It is speculated that categorizing HFpEF patients based upon underlying pathophysiological phenotypes may represent the key next step in delivering the right therapies to the right patients. Echocardiography may provide valuable insight into both the pathophysiology and underlying phenotypes in HFpEF. Echocardiography also plays a key role in the evaluation of patients with unexplained dyspnea, where HFpEF is suspected but the diagnosis remains unknown. The combination of the E/e' ratio and right ventricular systolic pressure has recently been shown to add independent value to the diagnostic evaluation of patients suspected of having HFpEF. Finally, echocardiography enables identification of the different causes that mimic HFpEF but are treated differently, such as valvular heart disease, pericardial constriction, and high-output heart failure or infiltrative myopathies such as cardiac amyloid. This review summarizes the current understanding of the pathophysiology and phenotyping of HFpEF with particular attention to the role of echocardiography in this context.

中文翻译：

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射血分数保留的舒张功能障碍和心力衰竭：通过使用非侵入性方法了解机制。


过去十年的研究极大地增进了我们对射血分数保留型心力衰竭（HFpEF）病理生理学的理解。然而，由于临床试验基本上未能找到有效的治疗方法，治疗选择仍然有限。这种失败的部分原因可能与机械异质性有关。据推测，根据潜在的病理生理表型对 HFpEF 患者进行分类可能是为正确的患者提供正确的治疗的关键下一步。超声心动图可以为 HFpEF 的病理生理学和潜在表型提供有价值的见解。超声心动图在不明原因呼吸困难患者的评估中也发挥着关键作用，这些患者怀疑有 HFpEF 但诊断仍不清楚。最近显示，E/e' 比值与右心室收缩压的结合可为疑似 HFpEF 患者的诊断评估增加独立价值。最后，超声心动图能够识别与 HFpEF 相似但治疗方式不同的不同病因，例如瓣膜性心脏病、心包缩窄、高输出量心力衰竭或浸润性肌病（例如心脏淀粉样蛋白）。本综述总结了目前对 HFpEF 病理生理学和表型的理解，特别关注超声心动图在这方面的作用。