Heart Failure with Preserved Ejection Fraction: Biomarkers, Phenotypes and Therapeutic Strategies.

Heart failure with preserved ejection fraction (HFpEF) is considered to be a diverse clinical syndrome that is characterized by the presence of symptoms of heart failure despite normal left ventricular systolic function. HFpEF has become known as a significant public health problem, especially in older adults and people with several cardiometabolic comorbidities. The pathophysiological mechanisms of HFpEF are multifactorial, with a range of factors including diastolic dysfunction; systemic inflammation; impairment of the endothelium; myocardial fibrosis; microvascular dysfunction; and metabolic dysregulation working together to create HFpEF. Through advances in biomarker research, the understanding of HFpEF mechanism(s) has been greatly advanced by identifying disease biomarkers that assist clinicians with risk assessment using natriuretic peptides, inflammatory mediators, markers of fibrosis and myocardial stress. Current studies are identifying various clinical phenotypes that are based on demographic factors, co-morbidity factors, hemodynamics, and biological signature and illustrate the heterogeneity of HFpEF. Current treatment approaches aim to provide comprehensive management of both cardiovascular and metabolic risk factors; optimize the management of comorbidity; and promote a healthy lifestyle and recommend pharmacological treatment based on evidence. Importantly, individualized pharmacological treatment approaches that incorporate biomarker profiling, phenotypic classification, and target therapies may provide more effective patient outcomes. A management system based on phenotype may lead to increased accuracy of HFpEF diagnosis; increased effectiveness of therapy; and improved long-term prognosis for patients with HFpEF. https://doi.org/10.52783/jchr.v16.i4.15470