Background: Heart failure with preserved ejection fraction (HFpEF) is a health care problem of epidemic proportions, currently accounting for roughly 3 million patients in the United States alone. Objective: To study, using validated angiography indices, coronary blood flow and myocardial perfusion of the microcirculation to assess whether there is greater microvascular disease (MVD) in patients with microvascular angina and HFpEF compared to those who do not have. Patients and methods: This retrospective study took place in El-Mahalla Cardiac Center on 160 patients with stable angina undergoing coronary angiography and echocardiography. All patients were subjected to complete history taking, full clinical examination, echocardiography, coronary angiography and angiography indices. Our patients were divided into two categories: 80 patients with HFpEF and 80 without HFpEF. Results: There were statistically significant differences between the studied groups. We found lower myocardial blush grades (MBG) in three coronary arteries in HFpEF than non-HFpEF patients, with good statistical significance regarding MBG left anterior descending (LAD) and MBG left circumflex (LCX). Also, there was statistically significant difference between the studied groups regarding total MBG value. Between thrombosis in myocardial infarction frame count (TFC) and MBG, there was a good correlation. The best cutoff of total TFC in diagnosis in diagnosis of HFpEF was ≥ 98.55 with sensitivity of 92.5% and specificity of 73.8%. Also, the best cutoff of total MBG in diagnosis in diagnosis of HFpEF was ≤ 6.55 with sensitivity of 80% and specificity of 87.5%. Conclusion: The HFpEF population has a greater involvement of microcirculation than patients without HFpEF.