The first step in diagnosing heart failure with preserved ejection fraction (HFpEF) is the evaluation of ejection fraction (EF) combined with the measurement of NT-proBNP. However, patients may not present a clear reduction in EF; additionally, NT-proBNP is reported to fluctuate in HFpEF patients depending on obesity, a common condition in HFpEF patients.

This means that NT-proBNP is not a suitable biomarker in a subgroup of patients. There is a need for non-invasive biomarkers accurately reflecting the risk of developing HFpEF as well as being able to diagnose HFpEF patients irrespective of comorbidities. A strategy of "one biomarker fits all" is unlikely to be applicable in HFpEF patients, and the future of diagnosis and risk assessment in HFpEF may be a combination of biomarkers.

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