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These difficulties arise primarily from the heterogeneous nature of the condition, the presence of various comorbidities and a wide range of phenotypic variations. Considering these challenges, current international guidelines endorse the utilization of invasive haemodynamic assessments, including resting and exercise haemodynamics, as the gold standard for enhancing diagnostic accuracy in cases where traditional diagnostic methods yield inconclusive results. These assessments are crucial not only for confirming the diagnosis but also for delineating the complex underlying pathophysiology, enabling the development of personalized treatment strategies, and facilitating the precise classification of HFpEF phenotypes. In this review, we summarize the haemodynamic changes observed in patients with HFpEF, comparing resting and exercise-induced parameters to those of normal subjects. Additionally, we discuss the current role of invasive haemodynamics in HFpEF assessment and highlight its utility beyond diagnosis, such as identifying HFpEF comorbidities, guiding phenotype-based personalized therapies and characterizing prognostication. Finally, we address the challenges associated with utilizing invasive haemodynamics and propose future directions, focusing on integrating these assessments into routine HFpEF care.<\/jats:p>","DOI":"10.1002\/ehf2.15163","type":"journal-article","created":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T02:39:12Z","timestamp":1731119952000},"page":"1558-1570","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Invasive Haemodynamic Assessment in Heart Failure with Preserved Ejection Fraction"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0086-5269","authenticated-orcid":false,"given":"Phuuwadith","family":"Wattanachayakul","sequence":"first","affiliation":[{"name":"Department of Medicine, Jefferson Einstein Hospital , Philadelphia, Pennsylvania ,","place":["USA"]},{"name":"Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veraprapas","family":"Kittipibul","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine , Durham, North Carolina ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husam M.","family":"Salah","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Yaku","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine , Chicago, Illinois 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