Heart failure (HF) is a diverse clinical syndrome resulting from structural or functional cardiac abnormalities, leading to impaired cardiac output and increased filling pressures. Early and accurate diagnosis is crucial to guide therapy, improve prognosis, and reduce morbidity and mortality. This review outlines a contemporary stepwise diagnostic framework that reflects a real-world approach, integrating clinical evaluation, laboratory testing, imaging, and hemodynamic assessment. Particular emphasis is placed on biomarkers, including B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), and echocardiography, which remain the backbone of HF diagnosis, while advanced imaging, genetic testing, and cardiopulmonary exercise testing are used to resolve diagnostic uncertainty in select complex cases. Rather than treating HF as a single entity, this review highlights specific etiologies, including ischemic, genetic, inflammatory, infiltrative, endocrine, and arrhythmogenic causes, and their specific diagnostic considerations. Novel biomarkers, implanted pressure monitoring, and artificial intelligence are examples of emerging techniques that are beginning to complement traditional testing and offer opportunities for early detection, individualized treatment, and preventive measures. By combining traditional and innovative diagnostic tools, clinicians can identify HF promptly, tailor therapy to underlying causes, and ultimately improve patient outcomes and quality of life.

Received: 13 January 2026

Accepted: 30 March 2026

Article published online:
08 April 2026

© 2026. International College of Angiology. This article is published by Thieme.

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