A model of progressive abnormalities in left ventricular function in heart failure across LVEF spectrum. Subclinical myocardial dysfunction triggered by cardiovascular risk factors such as age, hypertension and diabetes may present as depressed longitudinal deformation and decreased GLS but increased circumferential deformation and GCS. Progression is characterized by continuous impairment in longitudinal deformation. LVEF decreases at a point when circumferential function also starts to decline. GLS, global longitudinal strain; GCS, global circumferential strain; LVEF, LV ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.