Novel plasma and imaging biomarkers in heart failure with preserved ejection fraction

•We review limitations of current diagnostic guidelines for HFPEF.•We review novel plasma biomarkers applicable to HFPEF.•The most promising plasma and imaging biomarkers are highlighted.•We report advanced imaging techniques which may improve diagnosis and risk stratification.

Existing diagnostic guidelines for heart failure with preserved ejection fraction (HFPEF) primarily comprise natriuretic peptides and echocardiographic assessment, highlighting the role of diastolic dysfunction. However, recent discoveries of novel plasma markers implicated in pathophysiology of heart failure and technological advances in imaging provide additional biomarkers which are potentially applicable to HFPEF. The evidence base for plasma extra-cellular matrix (ECM) peptides, galectin-3, ST2, GDF-15 and pentraxin-3 is reviewed. Furthermore, the capabilities of novel imaging techniques to assess existing parameters (e.g. left ventricular ejection fraction, systolic & diastolic function, chamber size) and additional derangements of the ECM, myocardial mechanics and ischaemia evaluation are addressed.