Heart Failure With Mildly Reduced Ejection Fraction: A Call for a Precision Medicine Approach

Heart failure with mildly reduced ejection fraction (HFmrEF) is increasingly recognized as a distinct yet heterogeneous phenotype within the heart failure spectrum. Advances in diagnostic tools, including strain imaging, cardiac magnetic resonance, and molecular imaging, together with progress in genomics and biomarker profiling, have contributed to a deeper understanding of the complex pathophysiology of HFmrEF. Although direct, high-quality clinical evidence remains limited due to inconsistent definitions and under-representation in major trials, recent studies and subgroup analyses have offered promising therapeutic options for HFmrEF patients. Given the significant heterogeneity of HFmrEF, future management strategies should focus on precision medicine and individualized care. Integrating advanced imaging, biomarker profiling, genomics, and phenotype-specific assessment will be essential for optimizing patient outcomes. Embracing this precision-based approach promises to redefine care pathways and improve prognosis for this under-recognized patient population.