Diagnosing Heart Failure with Preserved Ejection Fraction in Obese Patients

Area of Science:

• Cardiology
• Obesity Medicine

Background:

• Obesity is a pandemic linked to increased heart failure (HF) risk, particularly HF with preserved ejection fraction (HFpEF).
• Diagnosing HFpEF is complex due to subtle cardiac remodeling, diastolic dysfunction, and elevated left ventricular (LV) filling pressures.

Purpose of the Study:

• To provide insights into the accurate diagnosis of HFpEF in obese patients.
• To address diagnostic challenges in specific clinical scenarios including obesity, atrial fibrillation (AF), and pulmonary hypertension (PH).

Main Methods:

• Review of current literature and diagnostic algorithms for HFpEF.
• Application of multimodality imaging and clinical assessments.

Main Results:

• Obesity complicates HFpEF diagnosis through suboptimal echocardiography, BSA-indexed parameter underestimation, and altered natriuretic peptide (NP) thresholds.
• Co-existing conditions like AF and PH in obese patients further challenge diastolic dysfunction evaluation.

Conclusions:

• Accurate HFpEF diagnosis in obese patients requires tailored approaches considering imaging quality and physiological alterations.
• Multimodality imaging and refined diagnostic algorithms are crucial for managing HFpEF in this high-risk population.