Biomarkers and transthoracic echocardiography for heart failure with preserved ejection fraction early detection

Abstract

Chronic heart failure with preserved ejection fraction (HFpEF) represents a major public health challenge due to its high prevalence, heterogeneous pathophysiology, and limited opportunities for early diagnosis. Accumulating evidence indicates that HFpEF is preceded by a prolonged subclinical phase characterized by structural and functional myocardial remodeling and chronic low-grade systemic inflammation. This review summarizes current evidence on instrumental and biochemical markers with potential utility for early detection and risk stratification of HFpEF. We highlight the diagnostic value of key echocardiographic parameters, including indices of left-sided cardiac remodeling and myocardial deformation imaging, as sensitive indicators of preclinical myocardial dysfunction. In addition, emerging data on circulating biomarkers of HFpEF are discussed, including natriuretic peptides and markers of inflammation, fibrosis, endothelial dysfunction, and cellulabr stress. Integration of imaging and biochemical parameters into multimarker diagnostic algorithms may facilitate earlier identification of high-risk individuals and improve preventive strategies for HFpEF.