[Diagnosis and treatment of heart failure with preserved ejection fraction].

The treatment of heart failure with preserved ejection fraction (HFpEF) involves symptomatic management of congestion with diuretics (class I recommendation) and treatment with sodium-glucose linked transporter 2 (SGLT2) inhibitors for improvement of the prognosis, which have a class I recommendation across the entire spectrum of left ventricular ejection fraction (LVEF) in the current guidelines. The data supporting the recommendation of SGLT2 inhibitors in HFpEF come from the EMPEROR-Preserved and DELIVER studies. The FINEARTS-HF study showed positive effects on cardiovascular death/heart failure hospitalization of the treatment of HFpEF patients with finerenone, a nonsteroidal mineralocorticoid receptor antagonist. The STEP-HFpEF (2023) and SUMMIT (2024) studies investigated the treatment with glucagon-like peptide 1 (GLP-1) analogs in patients with HFpEF and obesity and showed positive outcomes regarding quality of life and, in the latter study, positive effects on heart failure events. The treatment of severe mitral and tricuspid valve regurgitation impacts not only the symptom burden but also hospitalization and overall prognosis in HFpEF patients.