Introduction: Heart failure with mildly reduced ejection fraction has been a sensitive point in cardiology throughout its history, since it has had multiple names and a pathophysiology that can belong to both heart failure with Heart failure with reduced ejection fraction (less than 40%) and heart failure Heart failure with preserved ejection fraction (greater than 50%), which makes it difficult to generate standard recommendations for this entity. Objective: Recognize Heart failure with mildly reduced ejection fraction as an individual entity both for its diagnosis and follow-up, for which currently efforts are being made to develop phenotypes that allow us to go beyond the ejection fraction, mainly consolidated from characteristics valued by cardiac magnetic resonance imaging, as well as for its management Methods: Narrative review of the literature Results: Traditional therapies such as beta-blockers, ACE (Angiotensin converting enzyme) inhibitors, ARBs (Angiotensin receptor blockers), mineralocorticoid receptor antagonists, barely manage to give rise to guidelines for their use for medical consideration (IIb recommendation), as a novelty, iSGLT2 have been positioned as the standard therapy in heart failure syndrome regardless of the left ventricular ejection fraction.