EP 164: HFpEF in 2026: Phenotypes, Pathways and Precision Therapies

About this episode

In this insightful episode of Parallax, Dr Ankur Kalra is joined by Dr Barry Borlaug, Professor of Cardiology at Mayo Clinic and one of the world's leading experts in cardiac haemodynamics, for a comprehensive discussion on the evolving landscape of heart failure with preserved ejection fraction (HFpEF). Together, they explore the complexities of diagnosing and managing a syndrome that continues to challenge clinicians. Dr Borlaug explains why exercise right-heart catheterisation remains the gold standard for uncovering "hidden" HFpEF, particularly in patients with normal resting filling pressures, and provides a detailed overview of the Mayo Clinic's invasive exercise testing protocol. The conversation also traces the evolution of HFpEF phenotyping, from the traditional hypertensive patient to the increasingly recognised obesity-driven phenotype, highlighting the role of systemic inflammation, visceral adiposity and disease progression across the HFpEF spectrum. Dr Borlaug outlines what he describes as the modern therapeutic backbone for HFpEF in 2026, reviewing the evidence supporting SGLT2 inhibitors, mineralocorticoid receptor antagonists including finerenone, and incretin-ba