Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options

Heart failure (HF) is currently one of the most important public health problems. Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous disease characterized by normal or near-normal left ventricular ejection fraction, diastolic dysfunction and elevated left ventricular fi...

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Main Authors: Arnold Péter Ráduly, Máté Balázs Kovács, Attila Borbély
Format: Article
Language:English
Published: Promenade Kft 2025-02-01
Series:Cardiologia Hungarica
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Online Access:https://cardiologia.hungarica.eu/archive/2025-issues/volume-55-issue-1/heart-failure-with-preserved-ejection-fraction-hfpef-phenotypes-diagnostic-algorithms-and-new-therapeutic-options
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author Arnold Péter Ráduly
Máté Balázs Kovács
Máté Balázs Kovács
Attila Borbély
author_facet Arnold Péter Ráduly
Máté Balázs Kovács
Máté Balázs Kovács
Attila Borbély
author_sort Arnold Péter Ráduly
collection DOAJ
description Heart failure (HF) is currently one of the most important public health problems. Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous disease characterized by normal or near-normal left ventricular ejection fraction, diastolic dysfunction and elevated left ventricular filling pressures. The prognosis of HFpEF is similar to that of HF with reduced ejection fraction (HFrEF), but its management requires a personalised approach. The aim of this review article to summarize the current knowledge on HFpEF, including different phenotypes, diagnostic challenges, and novel therapeutic options. The heterogeneity of HFpEF and the importance of the individual phenotypes cannot be overemphasized, as this greatly influences the choice of treatment options and facilitates the development of personalized treatment strategies. Diagnosis of HFpEF is difficult and requires a combination of clinical symptoms, specific echocardiographic parameters and biomarkers. The H2FPEF score and the HFA-PEFF algorithm can help to estimate the probability of HFpEF. SGLT2 inhibitors have made a major breakthrough in the treatment of HFpEF, and their use is recommended as a class I recommendation in current guidelines. In addition, mineralocorticoid receptor antagonists, GLP-1 receptor agonists and appropriate treatment of the comorbidities also play an important role in the management of HFpEF.
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spelling doaj-art-d2870ce2ae754d65a8a23e5eba69723f2025-08-20T02:09:07ZengPromenade KftCardiologia Hungarica0133-55961588-02302025-02-01551404910.26430/CHUNGARICA.2025.55.1.40Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic optionsArnold Péter Ráduly0Máté Balázs Kovács1Máté Balázs Kovács2Attila Borbély3Debreceni Egyetem, Klinikai Központ, Kardiológiai Intézet, Kardiológiai és Szívsebészeti Klinika, Debrecen, Debreceni Egyetem, Általános Orvostudományi Kar, Kardiológiai Intézet, Klinikai Fiziológiai Tanszék, DebrecenDebreceni Egyetem, Klinikai Központ, Kardiológiai Intézet, Kardiológiai és Szívsebészeti Klinika, Debrecen Debreceni Egyetem, Klinikai Központ, Kardiológiai Intézet, Kardiológiai és Szívsebészeti Klinika, DebrecenDebreceni Egyetem, Klinikai Központ, Kardiológiai Intézet, Kardiológiai és Szívsebészeti Klinika, Debrecen 2Debreceni Egyetem, Általános Orvostudományi Kar, Kardiológiai Intézet, Klinikai Fiziológiai Tanszék, Debrecen Heart failure (HF) is currently one of the most important public health problems. Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous disease characterized by normal or near-normal left ventricular ejection fraction, diastolic dysfunction and elevated left ventricular filling pressures. The prognosis of HFpEF is similar to that of HF with reduced ejection fraction (HFrEF), but its management requires a personalised approach. The aim of this review article to summarize the current knowledge on HFpEF, including different phenotypes, diagnostic challenges, and novel therapeutic options. The heterogeneity of HFpEF and the importance of the individual phenotypes cannot be overemphasized, as this greatly influences the choice of treatment options and facilitates the development of personalized treatment strategies. Diagnosis of HFpEF is difficult and requires a combination of clinical symptoms, specific echocardiographic parameters and biomarkers. The H2FPEF score and the HFA-PEFF algorithm can help to estimate the probability of HFpEF. SGLT2 inhibitors have made a major breakthrough in the treatment of HFpEF, and their use is recommended as a class I recommendation in current guidelines. In addition, mineralocorticoid receptor antagonists, GLP-1 receptor agonists and appropriate treatment of the comorbidities also play an important role in the management of HFpEF.https://cardiologia.hungarica.eu/archive/2025-issues/volume-55-issue-1/heart-failure-with-preserved-ejection-fraction-hfpef-phenotypes-diagnostic-algorithms-and-new-therapeutic-optionsheart failurehfpefdiagnosisphenotypessglt2 inhibitors
spellingShingle Arnold Péter Ráduly
Máté Balázs Kovács
Máté Balázs Kovács
Attila Borbély
Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options
Cardiologia Hungarica
heart failure
hfpef
diagnosis
phenotypes
sglt2 inhibitors
title Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options
title_full Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options
title_fullStr Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options
title_full_unstemmed Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options
title_short Heart failure with preserved ejection fraction (HFpEF): phenotypes, diagnostic algorithms, and new therapeutic options
title_sort heart failure with preserved ejection fraction hfpef phenotypes diagnostic algorithms and new therapeutic options
topic heart failure
hfpef
diagnosis
phenotypes
sglt2 inhibitors
url https://cardiologia.hungarica.eu/archive/2025-issues/volume-55-issue-1/heart-failure-with-preserved-ejection-fraction-hfpef-phenotypes-diagnostic-algorithms-and-new-therapeutic-options
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AT matebalazskovacs heartfailurewithpreservedejectionfractionhfpefphenotypesdiagnosticalgorithmsandnewtherapeuticoptions
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