Heart failure with preserved ejection fraction (HFpEF) is increasingly
prevalent and represents more than half of all heart failure cases. It is defined
by the presence of heart failure signs and symptoms, identification of cardiac
structural abnormalities leading to high left ventricular filling pressures, and
an EF 50%. Common imaging findings in HFpEF include left ventricular
hypertrophy, diastolic dysfunction, left atrial enlargement, and elevated
pulmonary artery pressure ( 35 mm Hg). Echocardiography is the primary imaging
modality for diagnosing HFpEF. It can be complemented by cardiac magnetic
resonance (CMR) when further characterization is needed. Advances like real-time
3-dimensional echocardiography and speckle-tracking derived strain, as well as
tissue characterization by CMR, have furthered our understanding of the
mechanisms and aided in making the diagnosis of a diverse group of conditions
that can present as HFpEF. This review aims to touch upon the imaging methods of
characterizing HFpEF and discuss their role in specific disease entities.