{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:21:10Z","timestamp":1787602870275,"version":"build-2736575974"},"reference-count":79,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent and clinically heterogeneous syndrome characterized by substantial variability in pathophysiology, disease progression, therapeutic response, and clinical outcomes. Although conventional echocardiography remains central to diagnosis, traditional imaging parameters incompletely capture the biological complexity of HFpEF. Growing recognition of distinct disease phenotypes has stimulated interest in echocardiographic phenomapping as a strategy to improve patient characterization and support future precision medicine approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To critically review the contemporary role of echocardiography in HFpEF phenomapping, evaluate the strengths and limitations of emerging imaging biomarkers, and propose a conceptual echocardiographic framework for phenotype\u2010oriented classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive narrative review was conducted using PubMed\/MEDLINE, Scopus, and Web of Science. Contemporary evidence addressing myocardial mechanics, left atrial and right ventricular function, stress echocardiography, artificial intelligence, machine learning, and multimodal phenotyping was narratively reviewed, critically appraised, and synthesized, with emphasis on clinical applicability, methodological limitations, and future research directions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Contemporary echocardiography enables multidimensional assessment of myocardial structure, ventricular mechanics, atrial function, right ventricular performance, pulmonary vascular interactions, and exercise physiology, providing information beyond conventional diagnostic parameters. Advanced imaging biomarkers, including global longitudinal strain, myocardial work indices, left atrial strain, right ventricular strain, and right ventricular\u2013pulmonary arterial coupling, demonstrate incremental diagnostic and prognostic value in selected patient populations, although their routine clinical implementation remains limited by incomplete standardization, inter\u2010vendor variability, and the need for external validation. Exercise echocardiography further uncovers latent hemodynamic abnormalities and impaired cardiovascular reserve. Artificial intelligence and machine learning have identified candidate HFpEF phenogroups in research settings and may facilitate integration of multidimensional imaging data, although prospective validation and demonstration of clinical utility remain necessary before widespread adoption. Based on the current evidence, we propose a conceptual echocardiographic phenomapping framework encompassing myocardial\u2010dominant, atrial\u2010myopathy, pulmonary vascular\u2013right ventricular, and obesity\u2010metabolic phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HFpEF should be regarded as a heterogeneous spectrum of overlapping biological phenotypes rather than a single clinical entity. Modern echocardiography provides a comprehensive platform for multidimensional phenotyping and risk stratification that extends beyond conventional diagnostic assessment. However, important challenges \u2013 including biomarker standardization, external validation of proposed phenotypes, and demonstration of incremental value over existing clinical frameworks \u2013 must be addressed before phenotype\u2010guided management can be routinely incorporated into clinical practice. Future integration of advanced imaging biomarkers with artificial intelligence, exercise physiology, and biological profiling may further refine individualized approaches to HFpEF management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70582","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:45:41Z","timestamp":1785919541000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Echocardiographic Phenomapping in HFpEF: From Imaging Biomarkers to Precision Cardiovascular Medicine"],"prefix":"10.1111","volume":"43","author":[{"given":"Ehsan","family":"Shahverdi","sequence":"first","affiliation":[{"name":"Department of Cardiology Rhythmology Angiology and Intensive Care Medicine Klinikum Osnabr\u00fcck  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhythmology Angiology and Intensive Care Medicine Klinikum Osnabr\u00fcck  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhythmology Angiology and Intensive Care Medicine Klinikum Osnabr\u00fcck  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhythmology Angiology and Intensive Care Medicine Klinikum Osnabr\u00fcck  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_23_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.12.012"},{"key":"e_1_2_23_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.03.393"},{"key":"e_1_2_23_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_23_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.092"},{"key":"e_1_2_23_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-020-0363-2"},{"key":"e_1_2_23_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2107038"},{"key":"e_1_2_23_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz641"},{"key":"e_1_2_23_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.11.017"},{"key":"e_1_2_23_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv529"},{"key":"e_1_2_23_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2020.03.021"},{"key":"e_1_2_23_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jey042"},{"key":"e_1_2_23_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.010637"},{"key":"e_1_2_23_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12265-017-9756-y"},{"key":"e_1_2_23_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad195"},{"key":"e_1_2_23_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jead196"},{"key":"e_1_2_23_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908655"},{"key":"e_1_2_23_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.026807"},{"key":"e_1_2_23_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.045810"},{"key":"e_1_2_23_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021612"},{"key":"e_1_2_23_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1621"},{"issue":"3","key":"e_1_2_23_22_1","first-page":"172","article-title":"Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone","volume":"8","author":"Cohen J. B.","year":"2020","journal-title":"Heart Failure"},{"key":"e_1_2_23_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.07.029"},{"key":"e_1_2_23_24_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00157.2013"},{"key":"e_1_2_23_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy809"},{"key":"e_1_2_23_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs016"},{"key":"e_1_2_23_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032566"},{"key":"e_1_2_23_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015884"},{"key":"e_1_2_23_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab191"},{"key":"e_1_2_23_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(02)02864-3"},{"key":"e_1_2_23_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfp112"},{"issue":"12","key":"e_1_2_23_32_1","first-page":"1321","article-title":"Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update From the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"17","author":"Nagueh S. F.","year":"2016","journal-title":"European Journal of Echocardiography"},{"key":"e_1_2_23_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jep007"},{"key":"e_1_2_23_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.15.1788"},{"key":"e_1_2_23_35_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024822"},{"key":"e_1_2_23_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.051"},{"key":"e_1_2_23_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.630"},{"key":"e_1_2_23_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.09.052"},{"key":"e_1_2_23_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu184"},{"key":"e_1_2_23_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeag006"},{"key":"e_1_2_23_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.147"},{"key":"e_1_2_23_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.096"},{"key":"e_1_2_23_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht427"},{"key":"e_1_2_23_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2013.03.005"},{"key":"e_1_2_23_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jer021"},{"key":"e_1_2_23_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jey188"},{"key":"e_1_2_23_47_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.122.014419"},{"key":"e_1_2_23_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab154"},{"key":"e_1_2_23_49_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-21-0795"},{"key":"e_1_2_23_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.09.007"},{"key":"e_1_2_23_51_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.115.003754"},{"key":"e_1_2_23_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.088"},{"key":"e_1_2_23_53_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu193"},{"key":"e_1_2_23_54_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"issue":"11","key":"e_1_2_23_55_1","first-page":"1279","article-title":"New Speckle\u2010Tracking Algorithm for Right Ventricular Volume Analysis From Three\u2010Dimensional Echocardiographic Data Sets: Validation With Cardiac Magnetic Resonance and Comparison With the Previous Analysis Tool","volume":"17","author":"Muraru D.","year":"2015","journal-title":"European Journal of Echocardiography"},{"key":"e_1_2_23_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.01.051"},{"key":"e_1_2_23_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.06.014"},{"key":"e_1_2_23_58_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701"},{"key":"e_1_2_23_59_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.034646"},{"key":"e_1_2_23_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy331"},{"key":"e_1_2_23_61_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-078378"},{"issue":"9","key":"e_1_2_23_62_1","first-page":"2017","article-title":"Proposed Requirements for Cardiovascular Imaging\u2010related Machine Learning Evaluation (PRIME): A Checklist: Reviewed by the American College of Cardiology Healthcare Innovation Council","volume":"13","author":"Sengupta P. P.","year":"2020","journal-title":"Cardiovascular Imaging"},{"key":"e_1_2_23_63_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-026-72436-2"},{"key":"e_1_2_23_64_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2145-8"},{"key":"e_1_2_23_65_1","unstructured":"S.Tonekaboni S.Joshi M. D.McCradden andA.Goldenberg \u201cWhat Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use \u201d inProceedings of the 4th Machine Learning for Healthcare Conference. Proceedings of Machine Learning Research (PMLR 2019) 359\u2013380."},{"key":"e_1_2_23_66_1","doi-asserted-by":"publisher","DOI":"10.1002\/widm.1312"},{"key":"e_1_2_23_67_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01229-5"},{"key":"e_1_2_23_68_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa159"},{"key":"e_1_2_23_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2025.111122"},{"key":"e_1_2_23_70_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-020-00323-1"},{"key":"e_1_2_23_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.patcog.2024.110424"},{"issue":"16","key":"e_1_2_23_72_1","first-page":"200","article-title":"Federated Deep Learning for Predictive Healthcare: A Privacy\u2010Preserving AI Framework on Cloud\u2010Native Infrastructure","volume":"8","author":"Guntupalli R.","year":"2025","journal-title":"Vascular and Endovascular Review"},{"key":"e_1_2_23_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacbts.2016.11.010"},{"key":"e_1_2_23_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-821983-6.00004-7"},{"key":"e_1_2_23_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.06.050"},{"key":"e_1_2_23_76_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-024-01203-6"},{"key":"e_1_2_23_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2023.116673"},{"issue":"8","key":"e_1_2_23_78_1","article-title":"Wearable Devices and AI\u2010Driven Remote Monitoring in Cardiovascular Medicine: A Narrative Review","volume":"17","author":"Gaoudam N.","year":"2025","journal-title":"Cureus"},{"key":"e_1_2_23_79_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-020-00445-9"},{"key":"e_1_2_23_80_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-021-10176-9"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70582","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70582","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70582","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:28:26Z","timestamp":1787599706000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":79,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/echo.70582"],"URL":"https:\/\/doi.org\/10.1111\/echo.70582","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70582"}}