HEART FAILURE WITH PRESERVED EJECTION FRACTION: ADVANCES AND CHALLENGES IN DIAGNOSIS

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by diastolic dysfunction and marked phenotypic heterogeneity. Its prevalence is growing significantly, driven by population aging, obesity, and cardiometabolic diseases, and it constitutes a major public health problem. Early diagnosis remains a significant challenge due to the overlap of symptoms with other comorbidities and the limitations of traditional markers, such as natriuretic peptides, which may remain normal in some patients. In recent years, significant advances have been made, such as the development of clinical scores (H₂FPEF and HFA-PEFF), the application of advanced imaging techniques, such as global longitudinal strain and cardiac magnetic resonance imaging, and the investigation of new inflammatory and profibrotic biomarkers (ST2, galectin-3). These innovations contribute to a more accurate diagnostic assessment and enable better prognostic stratification. However, limitations related to cost, unequal access, and lack of validation in different population contexts still limit its widespread applicability. Therefore, understanding the pathophysiological mechanisms, recognizing current limitations, and rationally incorporating new diagnostic tools are fundamental steps to addressing the challenges of HFpEF and optimizing patient care.