{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T23:53:15Z","timestamp":1793749995258,"version":"4.6.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Although heart failure with preserved ejection fraction (HFpEF) has become the predominant heart failure subtype, it remains clinically under-recognized. HFpEF diagnosis is particularly challenging in the setting of obesity given the limitations of natriuretic peptides and resting echocardiography. We examined invasive and noninvasive HFpEF diagnostic criteria among individuals with obesity and dyspnea without known cardiovascular disease to determine the prevalence of hemodynamic HFpEF in the community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Research volunteers with dyspnea and obesity underwent resting echocardiography; participants with possible pulmonary hypertension qualified for invasive cardiopulmonary exercise testing. HFpEF was defined using rest or exercise pulmonary capillary wedge pressure criteria (\u226515 mm\u2005Hg or \u0394pulmonary capillary wedge pressure\/\u0394cardiac output slope, &gt;2.0 mm\u2005Hg\u00b7L\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7min\n                      <jats:sup>\u2212<\/jats:sup>\n                      1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among n=78 participants (age, 53\u00b113 years; 65% women; body mass index, 37.3\u00b16.8 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), 40 (51%) met echocardiographic criteria to undergo invasive cardiopulmonary exercise testing. In total, 24 participants (60% among the cardiopulmonary exercise testing group, 31% among the total sample) were diagnosed with HFpEF by rest or exercise pulmonary capillary wedge pressure (n=12) or exercise criteria (n=12). There were no differences in NT-proBNP (N-terminal pro-B-type natriuretic peptide; 79 [62\u2013104] versus 73 [57\u2013121] pg\/mL) or resting echocardiography (mitral E\/e\u2032 ratio, 9.1\u00b13.1 versus 8.0\u00b12.7) among those with versus without HFpEF (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt;0.05 for all). Distributions of HFpEF diagnostic scores were similar, with the majority classified as intermediate risk (100% versus 93.75% [H\n                      <jats:sub>2<\/jats:sub>\n                      FPEF] and 87.5% versus 68.75% [HFA-PEFF (Heart Failure Association Pretest assessment, echocardiography and natriuretic peptide, functional testing, and final etiology)] in those with versus without HFpEF).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Among adults with obesity and dyspnea without known cardiovascular disease, at least a third had clinically unrecognized HFpEF uncovered on invasive cardiopulmonary exercise testing. Clinical, biomarker, resting echocardiography, and diagnostic scores were similar among those with and without HFpEF. These results suggest clinical underdiagnosis of HFpEF among individuals with obesity and dyspnea and highlight limitations of noninvasive testing in the identification of HFpEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.123.011366","type":"journal-article","created":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T05:01:46Z","timestamp":1715662906000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Uncovering Unrecognized Heart Failure With Preserved Ejection Fraction Among Individuals With Obesity and Dyspnea"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2482-0444","authenticated-orcid":true,"given":"Leah B.","family":"Kosyakovsky","sequence":"first","affiliation":[{"name":"Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth E.","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1421-4969","authenticated-orcid":true,"given":"Jessica K.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Massachusetts General Hospital, Boston (L.M., G.D.L., R.M., E.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6510-0073","authenticated-orcid":true,"given":"Juhi K.","family":"Parekh","sequence":"additional","affiliation":[{"name":"Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Knauss","sequence":"additional","affiliation":[{"name":"Department of Medicine (H.K.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8108-8240","authenticated-orcid":true,"given":"Gregory D.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Massachusetts General Hospital, Boston (L.M., G.D.L., R.M., E.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0120-4630","authenticated-orcid":true,"given":"Rajeev","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Massachusetts General Hospital, Boston (L.M., G.D.L., R.M., E.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6993-9396","authenticated-orcid":true,"given":"Matthew","family":"Nayor","sequence":"additional","affiliation":[{"name":"Sections of Cardiology and Preventive Medicine and Epidemiology, Division of Internal Medicine, Boston University School of Medicine, MA (M.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9672-4841","authenticated-orcid":true,"given":"Jeremy M.","family":"Robbins","sequence":"additional","affiliation":[{"name":"Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6767-7687","authenticated-orcid":true,"given":"Robert E.","family":"Gerszten","sequence":"additional","affiliation":[{"name":"Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5504-5589","authenticated-orcid":true,"given":"Naomi M.","family":"Hamburg","sequence":"additional","affiliation":[{"name":"Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, MA (N.M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna N.","family":"McNeill","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC 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Heart 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