Contemporary approach to diagnosis and treatment of patients with heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome characterized by impaired left ventricular filling. It affects approximately 50% of patients with heart failure worldwide. Its complex pathophysiology involves the interaction between cardiomyocyte dysfunction and numerous comorbidities, including older age, female sex, type 2 diabetes, obesity, sleep apnea, hypertension, pulmonary hypertension, chronic obstructive pulmonary disease, coronary artery disease, and atrial fibrillation. Obesity, as a major risk factor, is chronic systemic inflammatory state that induces hemodynamic derangements and hormonal abnormalities that stress the cardiovascular system, with central obesity in women particularly contributing to HFpEF development. Diagnosis relies on clinical evaluation, measurement of natriuretic peptides, echocardiographic assessment, and exercise testing. Therapy includes SGLT-2 inhibitors, GLP-1 agonists, mineralocorticoid receptor antagonists, optimized diuretic therapy, management of comorbidities, lifestyle modifications, and structured exercise, improving prognosis and quality of life for patients.