The article reviews the role of endothelial dysfunction in heart failure (HF) and explores potential therapeutic options. Endothelial dysfunction is characterized by a shift to a proinflammatory and prothrombotic state, which can be bidirectionally influenced by HF. HFpEF, a form of HF with preserved ejection fraction (LVEF > 50%), may promote endothelial dysfunction through neurohormonal activation and shear stress, increasing ROS synthesis and reducing nitric oxide (NO) production. Systemic inflammation also contributes to endothelial damage in HFpEF. Clinical trials suggest that drugs targeting endothelial dysfunction may be therapeutic options for HF and cardiovascular disease (CVD). The review highlights the pathogenetic correlation between endothelial dysfunction and HF and discusses various methods for measuring endothelial function, including intracoronary artery infusions, flow-mediated vasodilation (FMD), and peripheral arterial tonometry (PAT). It also examines the pathophysiology of endothelial dysfunction, its role in HF, and the potential of targeted therapies to improve outcomes.The article reviews the role of endothelial dysfunction in heart failure (HF) and explores potential therapeutic options. Endothelial dysfunction is characterized by a shift to a proinflammatory and prothrombotic state, which can be bidirectionally influenced by HF. HFpEF, a form of HF with preserved ejection fraction (LVEF > 50%), may promote endothelial dysfunction through neurohormonal activation and shear stress, increasing ROS synthesis and reducing nitric oxide (NO) production. Systemic inflammation also contributes to endothelial damage in HFpEF. Clinical trials suggest that drugs targeting endothelial dysfunction may be therapeutic options for HF and cardiovascular disease (CVD). The review highlights the pathogenetic correlation between endothelial dysfunction and HF and discusses various methods for measuring endothelial function, including intracoronary artery infusions, flow-mediated vasodilation (FMD), and peripheral arterial tonometry (PAT). It also examines the pathophysiology of endothelial dysfunction, its role in HF, and the potential of targeted therapies to improve outcomes.