Background: There is no enough information available at this time to determine if patients with stable heart failure and preserved ejection fraction also experience higher left ventricular strain and high-sensitivity troponin, which are associated with a worsening of the condition. Aim: To predict and early diagnose left ventricular dysfunction in patients with heart failure with preserved ejection fraction. Methods: This case control study was conducted on 48 subjects diagnosed with heart failure with preserved ejection fraction (HFpEF), at Cardiology Department, Faculty of Medicine, Zagazig University. The patients were divided into 2 equal groups: case group (n=24): included patients diagnosed with HFpEF with diastolic dysfunction and control group (n=24): included healthy individuals. High-sensitivity cardiac troponin T and left ventricular strain were assessed in all subjects. Results: High sensitivity cardiac troponin T, GLS, GDSIVR, GDSE, SRE, E/SRE and SRIVR were considerably greater in the cases group as opposed to the control group (P<0.05). Conclusion: In comparison to normal controls, our investigation revealed that HFpEF patients with diastolic dysfunction had significantly higher hs-cTnT levels, more severe abnormalities in left ventricular strain, and more advanced diastolic dysfunction