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Review
. 2025 Dec 1;86(6):522-534.
doi: 10.1097/FJC.0000000000001755.

Current Challenges for the Diagnosis of HFpEF and Possible Simplification of the Diagnostic Approach

Marco Bernardi  1   2 , Michele Golino  3 , Luigi Spadafora  1   2 , Gianmarco Sarto  4 , Maurizio Forte  5 , Beatrice Simeone  4 , Erica Rocco  4 , Valentina Valenti  1   6 , Sonia Schiavon  1 , Antonio Esposito  4 , Elena Di Florio  3 , Lorenzo Scalia  7 , Lorenzo Lo Sasso  8 , Giacomo Frati  1   5 , Giuseppe Biondi Zoccai  1   6 , Francesco Versaci  2 , Sebastiano Sciarretta  1   5
Affiliations
Review

Current Challenges for the Diagnosis of HFpEF and Possible Simplification of the Diagnostic Approach

Marco Bernardi et al. J Cardiovasc Pharmacol. .

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a prevalent and multifaceted clinical syndrome, often underdiagnosed because of its heterogeneous presentation and overlapping comorbidities. Recent randomized trials have demonstrated the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in reducing heart failure hospitalizations and cardiovascular mortality. In this review, we analyze the main challenges of HFpEF diagnosis and discuss current diagnostic algorithms. Based on recent evidence and recommendations, we propose a possible way to simplify and accelerate the diagnostic process of HFpEF, to support an early initiation of disease-modifying therapies. An interactive web-based version of the proposed algorithm is available at www.hfpefdiagnosis.com for research or exploratory purposes.

Keywords: HFpEF; SGLT2 inhibitors; diagnostic algorithm; heart failure with preserved ejection fraction.

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Conflict of interest statement

G. Biondi-Zoccai has consulted, lectured, and/or served as advisory board member for Abiomed, Advanced Nanotherapies, Aleph, Amarin, AstraZeneca, Balmed, Cardionovum, Cepton, Crannmedical, Endocore Lab, Eukon, Guidotti, Innovheart, Meditrial, Menarini, Microport, Opsens Medical, Synthesa, Terumo, and Translumina, outside the present work. All other authors report no conflict of interest.

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