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Cardiovascular Diabetology
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Open Access 07-02-2025 | Heart Failure | Review

Challenges in the diagnosis of heart failure with preserved ejection fraction in individuals with obesity

Authors: Bas M. van Dalen, Jie Fen Chin, Praveen A. Motiram, Anneke Hendrix, Mireille E. Emans, Jasper J. Brugts, B. Daan Westenbrink, Rudolf A. de Boer

Published in: Cardiovascular Diabetology | Issue 1/2025

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Abstract

The rising prevalence of obesity and its association with heart failure with preserved ejection fraction (HFpEF) highlight an urgent need for a diagnostic approach tailored to this population. Diagnosing HFpEF is hampered by the lack of a single non-invasive diagnostic criterion. While this makes a firm diagnosis of HFpEF already notoriously difficult in the general population, it is even more challenging in individuals with obesity. The challenges stem from a range of factors, including the use of body mass index as a conceptually suboptimal indicator of health risks associated with increased body mass, symptom overlap between HFpEF and obesity, limitations in physical examination, difficulties in electrocardiographic and echocardiographic evaluation, and reduced diagnostic sensitivity of natriuretic peptides in individuals with obesity. In this review, we examine these diagnostic challenges and propose a diagnostic algorithm specifically tailored to improve the accuracy and reliability of HFpEF diagnosis in this growing patient demographic.

Graphical abstract

Proposed obesity-adjusted HFpEF score. HFpEF, Heart failure with preserved ejection fraction. Created with BioRender.com.
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Metadata
Title
Challenges in the diagnosis of heart failure with preserved ejection fraction in individuals with obesity
Authors
Bas M. van Dalen
Jie Fen Chin
Praveen A. Motiram
Anneke Hendrix
Mireille E. Emans
Jasper J. Brugts
B. Daan Westenbrink
Rudolf A. de Boer
Publication date
07-02-2025
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2025
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-025-02612-z

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