Heart Failure with Preserved Ejection Fraction: A Clinical Reappraisal View PDF

^*Dedeepya Sree Parna
Medicine, Kamineni Academy Of Medical Sciences And Research Centre, Hyderabad, Telangana, India
Panchajanya Kolli
Medicine, Long Island University, Brooklyn, New York, United States
Sai Karthic Ananthakrishnan
Medicine, Indira Gandhi Medical College & Research Institute, Kathirkamam, Puducherry, India
Sahithi Reddy Daivamdinne
Medicine, Mamata Academy Of Medical Sciences, Hyderabad, Telangana, India

^*Corresponding Author:

Dedeepya Sree Parna
Medicine, Kamineni Academy Of Medical Sciences And Research Centre, Hyderabad, Telangana, India

Published on: 2026-02-06

Abstract

Heart failure with preserved ejection fraction (HFpEF) poses a significant and growing clinical burden, yet its complex pathophysiology and diagnostic challenges hinder effective management, necessitating a comprehensive reappraisal of current knowledge. This review highlights the heterogeneous nature of HFpEF, emphasizing the critical roles of comorbidities such as hypertension, diabetes, and obesity in driving disease progression, while also exploring advancements in diagnostic tools like the HFA-PEFF score and emerging biomarkers. Furthermore, it evaluates the therapeutic potential of SGLT2 inhibitors, anti-inflammatory agents, and personalized treatment strategies, offering insights into their mechanisms and clinical benefits. The review underscores the limitations of current therapies and the need for improved phenotyping to guide precision medicine approaches. Future research should prioritize large-scale trials to validate novel interventions, refine diagnostic criteria, and explore integrative care models that address both cardiac and systemic contributors to HFpEF. By bridging gaps in understanding and treatment, this review aims to inform clinical practice and inspire innovative solutions for improving outcomes in HFpEF patients.

Keywords

Biomarkers, Comorbidities, Diagnosis, Heart failure with preserved ejection fraction, Pathophysiology, SGLT2 inhibitors, Treatment strategies

Introduction

HFpEF is increasingly recognized as a significant clinical syndrome characterized by the presence of heart failure symptoms alongside a normal or near-normal left ventricular ejection fraction (LVEF ≥ 50%) [1-3]. This condition accounts for approximately half of all heart failure cases globally, with its incidence rising by 45% in recent years [1]. Despite this growing prevalence, HFpEF remains poorly understood, with no standardized guidelines for diagnosis or treatment, leading to challenges in patient management and outcomes [1].

The clinical reappraisal of HFpEF has been approached through various perspectives, emphasizing prognostic assessment, pathophysiological mechanisms, therapeutic strategies, and diagnostic challenges. Prognostic tools such as the HFA-PEFF score have demonstrated significant clinical relevance in predicting outcomes in HFpEF patients. Sotomi et al. [4] highlighted the prognostic significance of this scoring system, associating higher scores with increased risks of all-cause mortality and heart failure readmissions, thereby underscoring its utility in clinical risk stratification.