Heart failure (HF) with preserved ejection fraction (HFpEF) is becoming the predominant form of HF. Understanding cardiac structure and function in this syndrome is highly relevant for diagnosis, prognosis, pathophysiology, and management. However, identifying cardiac dysfunction in HFpEF can be challenging and requires an integrated assessment of cardiac structure, systolic and diastolic function, and hemodynamics. Comprehensive transthoracic echocardiography is the noninvasive imaging test of choice for evaluating patients with HF. Importantly, cardiac dysfunction may not be present at rest in HFpEF but may be unmasked with exercise or pharmacologic stress testing. Imaging in HFpEF is reviewed.