IMPACT OF EARLY DETECTION AND MANAGEMENT STRATEGIES ON OUTCOMES OF HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract

Heart failure with preserved ejection fraction represents nearly half of all heart failure cases and is associated with high morbidity and mortality despite preserved systolic function. Its heterogeneous pathophysiology and lack of effective therapies necessitate integrative investigative approaches. A prospective mixed-methods experimental design was employed, integrating quantitative hemodynamic assessment, advanced echocardiography, biomarker profiling, cardiopulmonary exercise testing, and qualitative clinical phenotyping. Multivariate regression modeling and unsupervised clustering were applied to identify mechanistic drivers and phenotype-specific risk profiles. The results demonstrated marked heterogeneity in diastolic function, myocardial stiffness, microvascular integrity, inflammatory burden, and ventricular–vascular coupling across HFpEF phenotypes. Nonlinear relaxation dynamics and elevated filling pressures were observed despite preserved ejection fraction. Cardiopulmonary exercise testing revealed significant impairment in peripheral oxygen utilization, while biomarker analysis confirmed heightened systemic inflammation. Integrated multivariate models significantly outperformed isolated parameters in predicting adverse outcomes, and phenotype clustering identified distinct subgroups with divergent prognostic trajectories driven by metabolic, inflammatory, and vascular mechanisms. HFpEF is a systemic, multiorgan syndrome characterized by complex nonlinear interactions that are not adequately captured by conventional diagnostic or therapeutic strategies. Precision-based, phenotype-specific approaches informed by integrated physiological and biochemical profiling are essential to improve clinical outcomes.