Table 1.

Summary evolution of the diagnostic framework of HFpEF.

HFpEF diagnosis	Evolution summary	Reference
Biomarkers integration	The integration of circulating biomarkers, markers of metabolic dysfunction, and microRNAs has been incorporated into HFpEF classification. Identified biomarkers include those related to myocardial injury, extracellular fibrosis, inflammation, and endothelial dysfunction, providing valuable information for diagnosis, prognosis, and personalized therapy.	[16]
Advancements in imaging techniques	Echocardiography assesses diastolic function, while CMR-derived indices, including GLS and ECV, discriminate between different HFpEF phenotypes. LGE on CMR aids in risk stratification.	[17, 26, 27, 28, 29]
Scoring systems and challenges	H2FPEF score complements traditional diagnostic tools. Future research should focus on prospective validation and integrating these scores into routine clinical practice.	[30, 31, 32]
Diagnostic algorithm development	Development of stepwise diagnostic algorithms such as HFA-PEFF, incorporating pre-assessment, echocardiography, functional testing, and final etiology phases. The H2FPEF score provides a practical tool for initial risk stratification.	[30, 31, 32]

HFpEF, heart failure with preserved ejection fraction; CMR, cardiovascular magnetic resonance; LGE, late gadolinium enhancement; GLS, global longitudinal strain; ECV, extracellular volume; H2FPEF, heart 2 preserved ejection fraction; HFA-PEFF, Heart Failure Association-preserved ejection fraction.