and cellular energetics.152 At the cellular level, it is thought to decrease the enzymatic activity of both the Krebs cycle and the mitochondrial respiratory chain.153 Iron deficiency has been related to decreased exercise capacity (measured with both peak VO 2 max and 6-minute walking distance) and quality of life in HFpEF patients.154 Moreover, a recent study has shown that iron deficiency in HFpEF is significantly associated with a 3.5-fold increase in all-cause mortality, but not with HF hospitalisations ( Table 3 ).155 The on-going FAIR-HFpEF study is evaluating the effects of intravenous iron therapy on exercise capacity, mortality and HF-related hospitalisation rates, as has been previously reported in HFrEF patients.156 Novel Biomarkers Circulating microRNAs Circulating microRNAs (miRNAs) offer attractive potential as epigenetic disease biomarkers by virtue of their biological stability and ready accessibility in liquid biopsies
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