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

## TL;DR

Heart failure with mildly reduced ejection fraction is a complex condition that needs a more personalized treatment approach using advanced tools like imaging and genomics.

## Contribution

The paper advocates for a precision medicine approach to better manage the heterogeneity of HFmrEF.

## Key findings

- HFmrEF is a distinct but varied condition within heart failure.
- Advanced imaging and biomarkers can improve risk assessment for HFmrEF.
- More clinical evidence is needed for tailored therapies in HFmrEF.

## Abstract

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.

•Heart failure with mildly reduced ejection fraction represents a clinically significant yet heterogeneous phenotype within the heart-failure spectrum.•Leverage advanced imaging, biomarkers, and genomic profiling to enhance phenotyping and risk stratification.•Clinical evidence for heart failure with mildly reduced ejection fraction is increasing, although most data remain extrapolated from heart failure with preserved ejection fraction trials.•Future progress relies on integrating precision medicine and artificial intelligence to enable data-driven individualized care.

Heart failure with mildly reduced ejection fraction represents a clinically significant yet heterogeneous phenotype within the heart-failure spectrum.

Leverage advanced imaging, biomarkers, and genomic profiling to enhance phenotyping and risk stratification.

Clinical evidence for heart failure with mildly reduced ejection fraction is increasing, although most data remain extrapolated from heart failure with preserved ejection fraction trials.

Future progress relies on integrating precision medicine and artificial intelligence to enable data-driven individualized care.