Skip to main content

Diagnosis of heart failure in the elderly: current status and future perspectives for echocardiographic diagnostic systems


Since Japan is experiencing a super-aged society, the number of heart failure patients (HF) is increasing remarkably. In particular, the increase in heart failure with preserved ejection fraction (HFpEF), which is common in the elderly, has characterized the last decade. The diagnosis of HFpEF by assessment of left ventricular (LV) diastolic dysfunction, which is also referred to as diastolic heart failure, is an important role assigned to echocardiography. The Doppler echocardiographic algorithm for the evaluation of LV diastolic function from the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) has been widely used to diagnose HFpEF. This article will focus on the HFpEF diagnostic algorithm proposed in 2018 by the Heart Failure Association of the European Society of Cardiology (HFA-PEFF score) based on autologous elderly cases. We compared the usefulness of the HFA-PEFF score with the ASE/EACVI algorithm. By comparing HFpEF patients with healthy elderly subjects and hypertensive patients with no history of HF, this paper will identify the usefulness and challenges of the HFA-PEFF score in the assessment of the elderly. The echocardiographic findings in at-risk or early-stage elderly patients with HFpEF will also be summarized. In addition, this review will describe future prospects for echocardiographic diagnostic systems for the prevention of HF onset and HF progression in the elderly and propose the concept of “early HFpEF”.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8


  1. Arai H, Ouchi Y, Toba K, Endo T, et al. Japan as the front-runner of super-aged societies: perspectives from medicine and medical care in Japan. Geriatr Gerontol Int. 2015;15:673–87.

    Article  Google Scholar 

  2. United Nations. Department of Economic and Social Affairs. Population Division. World Population Ageing. 2019. Accessed 8 May 2020

  3. Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17:559–73.

    CAS  Article  Google Scholar 

  4. Seo Y, Ishizu T, Ieda M, et al. Elderly Japanese standard data of echocardiography from J-LONG study. J Echocardiogr. 2020;18:175–82.

    Article  Google Scholar 

  5. Nagueh SF, Smiseth OA, Appleton CP, et al. 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. Eur Heart J Cardiovasc Imaging. 2016;17:1321–60.

    Article  Google Scholar 

  6. Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40:3297–317.

    Article  Google Scholar 

  7. Seo Y, Ishizu T, Ieda M, et al. Clinical usefulness of the HFA-PEFF diagnostic scoring system in identifying late elderly heart failure with preserved ejection fraction patients. Circ J. 2021;85:604–11.

    CAS  Article  Google Scholar 

  8. Barandiarán Aizpurua A, Sanders-van Wijk S, et al. Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction. Eur J Heart Fail. 2020;22:413–21.

    Article  Google Scholar 

  9. Tsutsui H, Isobe M, Ito H, Japanese Circulation Society and the Japanese Heart Failure Society Joint Working Group, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure - digest version. Circ J. 2019;25:2084–184.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Yoshihiro Seo.

Ethics declarations

Conflict of interest

The author declares that there are no conflicts of interest.

Ethical approval

The investigation conformed with the principles outlined in the Declaration of Helsinki. The J-LONG study was approved by the local ethics committee of each participating institution. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Seo, Y. Diagnosis of heart failure in the elderly: current status and future perspectives for echocardiographic diagnostic systems. J Med Ultrasonics 49, 381–388 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Heart failure
  • Diagnostic system
  • Elderly
  • Echocardiography
  • BNP