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Background:Arterial stiffness remains a well-recognized risk factor for adverse cardiovascular outcomes. Recently, vascular wall kinetics and elastic properties of the carotid artery can be assessed utilizing deformation measures. Data regarding such measure remained unexplored in heart failure with preserved ejection fraction (HFpEF).Objective:We investigate the functional alterations, diagnostic yields and prognostic implications of carotid arterial deformations in subjects with higher cardiovascular risk factors and HFpEF.Methods and Results:Among 251 patients (mean age 65.8? 9.9 years, 65.7% female) from outpatient clinics, we used carotid arterial circumferential strain (CCS) utilizing 2D speckle-tracking in 3 categories including: control (n=53), obesity/high risk (n=146), and HFpEF (n=52). Significant reduction of carotid circumferential strain (CCS), strain rate (CCSR), and radial strain (CRS) were observed across control, obesity/at risk and HFpEF 3 groups (4.15% vs. 3.69% vs. 3.39%, ANOVA p: ?0.001). CCS, CCSR, CRS and radial displacement (CRD) correlated with longitudinal ventricular strain (r=-0.31, -0.23, 0.15, 0.14, all p<0.05), with aging, hypertension, HFpEF and pulse rate independently predict CCS in multi-variate regression model (all p<0.05). During follow-up, those who developed HF showed markedly reduced CCS, CCR and CRS compared to non-event subjects (all p<0.05), with CCS set at 3.28% showed significantly higher prognostic events (Harrel-C: 0.71, adjusted HR: 0.22 [95% CI: 1.24-3.97], p=0.007).Conclusions:Carotid artery deformations using 2D speckle-tracking imaging provides novel insights on arterial kinetics and improved vascular characterization. These measures further highlight mechanistic significance on ventricular-arterial coupling with prognostic implications.