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The participants were categorized by WHtR and EF quartiles. Outpatient or telephone follow-up occurred every 6 months after the diagnosis of heart failure. The primary endpoint was all-cause mortality at 48 months. Cox proportional hazard regression analyses were employed to evaluate the association between WHtR and all-cause mortality. Among 859 enrolled participants, 545 (63.4%) were male, and the mean age was 65.2 \u00b1 11.1 years. After adjusting for age and sex, WHtR demonstrated a strong correlation with both BMI (correlation = 0.703, P = 0.000) and WHR (correlation = 0.609, P = 0.000). Individuals with a high WHtR (\u22650.50) had a higher prevalence of hypertension (56.4% vs. 39.6%) and diabetes (26.5% vs. 13.7%), higher levels of TC (3.61 \u00b1 1.55 vs. 3.36 \u00b1 0.90 mmol\/L), TG (1.40 \u00b1 0.81 vs. 1.06 \u00b1 0.59 mmol\/L), and LDL-C (2.03 \u00b1 0.85 vs. 1.86 \u00b1 0.76 mmol\/L) compared with patients with low WHtR (&amp;lt;0.50). NT-proBNP levels were inversely correlated with EF values in both low and high WHtR groups. A total of 149 (18.9%) patients died at the conclusion of the follow-up period. The incidence of all-cause and cardiovascular death was higher in the low WHtR group compared with the high WHtR group [HRs = 1.83 (1.30\u20132.58), 1.96 (1.34\u20132.88), respectively]. There was no significant difference in noncardiovascular mortality or rehospitalization rates between the two groups. Patients with HFrEF\/low WHtR exhibited a markedly elevated risk of all-cause mortality [HR = 2.31; (95% CI: 1.24\u20134.30)], heart failure mortality [HR = 3.52; (95% CI: 2.92\u20138.80)], and noncardiovascular mortality [HR = 4.59; (95% CI: 1.19\u201317.76)] compared with patients with HFrEF\/high WHtR. WHtR has a negligible effect on the risk of all-cause and cardiovascular mortality in heart failure patients with preserved EFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The obesity paradox, as delineated by WHtR, is observed in patients with HFrEF, yet absent in those with HFpEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15029","type":"journal-article","created":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T15:39:57Z","timestamp":1726587597000},"page":"290-303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Relationship Between Waist-to-Height Ratio and Heart Failure Outcome: A Single-Centre Prospective Cohort Study"],"prefix":"10.1093","volume":"12","author":[{"given":"Ping","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Xijing Hospital, Air Force Medical University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xijing Hospital, Air Force Medical University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danni","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Xi\u2019an Jiaotong University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boxiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Xi\u2019an Jiaotong University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hange","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xijing Hospital, Air Force Medical University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guotao","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xijing Hospital, Air Force Medical University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xijing Hospital, Air Force Medical University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Xi\u2019an Jiaotong University , Xi\u2019an ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,17]]},"reference":[{"key":"2026012113062522800_ehf215029-bib-0001","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: a comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc Res"},{"key":"2026012113062522800_ehf215029-bib-0002","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1152\/physrev.00017.2007","article-title":"Cardiac remodeling in obesity","volume":"88","author":"Abel","year":"2008","journal-title":"Physiol Rev"},{"key":"2026012113062522800_ehf215029-bib-0003","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMsa073166","volume-title":"Adolescent overweight and future adult coronary heart disease","author":"Kirsten Bibbins-Domingo","year":"2007"},{"key":"2026012113062522800_ehf215029-bib-0004","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1161\/01.ATV.0000216787.85457.f3","article-title":"Obesity and cardiovascular disease","volume":"26","author":"Poirier","year":"2006","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2026012113062522800_ehf215029-bib-0005","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.jchf.2016.11.011","article-title":"Obesity and survival with heart failure","volume":"5","author":"deFilippi","year":"2017","journal-title":"JACC: Heart Failure"},{"key":"2026012113062522800_ehf215029-bib-0006","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1007\/s13679-020-00394-x","article-title":"Is there an obesity paradox in critical illness? 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