Half of patients with heart failure are presented with preserved
ejection fraction (HFpEF). The pathophysiology of these patients is
complex but increased left ventricular (LV) stiffness is proved to play
a key role. However, the application of this parameter was limited since
its measurements requires invasive catheterization. With advances in
ultrasound technology, new advances have been achieved in the assessment
of LV chamber or myocardial stiffness using noninvasive
echocardiography. Therefore, this review was carried out to summarize
the pathophysiological mechanisms, correlations with invasive LV
stiffness constant, applications in different populations as well as the
limitations of echocardiography-derived indices for assessment of both
LV chamber and myocardial stiffness. LV chamber stiffness indices such
as E/e’/LVEDV, E/SRe/LVEDV, and DPVQ were derived on the basis of the
relationship between echocardiographic parameters of LVFP and LV size.
However, all these methods are surrogate and lumped measurements,
relying on E/e’ or E/SRe for evaluating LVFP. The limitations of E/e’ or
E/SRe in assessment of LVFP may contribute to the moderate correlation
between E/e’/LVEDV or E/SRe/LVEDV and LV stiffness constant. Even the
best validated measurement (DPVQ) is considered unreliable in the
individual patient. Compared to E/e’/LVEDV and E/SRe/LVEDV, I
PVA/IA and F PVA/FA may display better
performance in assessing LV chamber stiffness as evidenced by a higher
correlation with LV stiffness constant. However, only one study has been
conducted in the literature on the exploration and application of I
PVA/I A and F PVA/F
A, and its accuracy in assessing LV chamber stiffness
remains to be confirmed. In terms of echocardiographic indices for LV
myocardial stiffness evaluation, the parameters of EMI/DWS, iVP and SWI
were proposed. Despite alteration of DWS and its predictive value of
adverse outcomes in various populations have been widely validated, it
was found that DWS may be better considered as an overall marker of
cardiac function performance instead of pure myocardial stiffness. As
for the iVP and SWI, the validities of these two indices in assessing LV
myocardial stiffness have not been confirmed in invasive studies. More
echocardiographic indices with higher sensitivities and specificities
warrant to be further uncovered to evaluate LV stiffness.