Preheart failure: a stage of chronic heart failure

Heart failure (HF) can range from preHF (PHF), a state of high risk of developing myocardial dysfunction, to advanced chronic HF, which may be graded into four stages. The risk factors of HF could be primarily concerned with diet and lifestyle and secondarily with obesity, hypertension, myocardial infarction, and cardiomyopathy. Both types of risk factors can damage the myocytes, leading to cardiac hypertrophy and alterations in the size and shape of cardiac cells to condition from physiological subcellular remodeling to pathological deformation, as PHF. Oxidative stress and inflammation in the cardiac tissues predispose the intracellular Ca2+ overload, activation of proteases and phospholipases, mitochondrial dysfunction, and alterations in cardiac gene expression resulting into the alterations in the biochemical composition, molecular structure, and function of different subcellular organelles with pathological subcellular remodeling or myocardial deformation. Dhalla et al. proposed that subcellular remodeling may be intimately involved in the transition of cardiac hypertrophy or cardiac deformation. Nanda et al. proposed that the identification of PHF is possible in early stage via speckle-tracking echocardiography (STE), in particular, 3D echocardiography. There may be increase in angiotensin-converting enzyme in the tissues with the increase in brain RAAS activity, along with hsTroponin T in association with PHF. These physiopathological markers of PHF could be examined via STE as global longitudinal strain and other myocardial strains. There is a gap in the knowledge that HF with preserved ejection fraction, which may also include PHF, can be effectively treated by current therapy. Cardiac strain is frequently attenuated in PHF, which may be utilized for the evaluation of disease progression and the effect of early therapeutic interventions.