Given the complexity of Heart Failure with Preserved Ejection Fraction (HFpEF), a condition with a poor prognosis and limited therapeutic options, this thesis explores two patient cohorts to identify key biomarkers and metabolic drivers. Congestion, a central element in HFpEF, is marked by carbohydrate antigen (CA) 125, a biomarker of severity and hospitalization risk. Beyond congestion, targeted metabolomics reveals plasma myo-inositol as a distinct marker of fibrosis and renal decline, while lipidomic analysis identifies unique HFpEF phenotypes with specific metabolic profiles. Epicardial adipose tissue (EAT) also contributes to HFpEF, positioning EAT as a promising therapeutic target. These findings support the integration of biomarkers and metabolic profiling for more targeted therapeutic approaches.