Integrating the knowledge: Strength and limitations of echo techniques to diagnose and stage heart failure with preserved ejection fraction

Assessment of diastolic function is nowadays done noninvasively; such an approach provides unambiguous information in a large, albeit not complete, proportion of patients suffering from heart failure with preserved ejection fraction (HFpEF). In this review, echocardiography is used in order to diagnose and stage diastolic dysfunction, including abnormal hemodynamic features that can be elicited under stress, three-dimensional echocardiography implementation and most recent 'diastolic indexes'. It must be admitted, however, that there is still uncertainty in diagnosing borderline cases, where a return to invasive data can contribute to a definitive characterization of the HFpEF patients.