The Conundrum of HFpEF Definition: Non-Invasive Assessment Uncertainties and Alternative Diagnostic Strategies

•Current Diagnostic criteria for HFpEF are relatively applied in clinical practice and in larger clinical trials because of sophisticated algorithm and scarce reproducibility.•This is due to the poor concordance between non-invasive and invasive measurements of LV filling pressure associated with LVEF mechanistic and hemodynamic pitfalls.•A diagnostic criteria shifting from LVEF centric vision to different systolic function evaluation based on stroke volume and LV volume analysis, could became an optional criteria for better screening HF patients accordingly with effective contractile function.•The wide cutoff of echocardiographic features recruited in clinical trials may imply different HFpEF stage: a step strategy including morphological, functional, and associated diseases is purposed to identify disease progression.