{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:52:20Z","timestamp":1782305540375,"version":"3.54.5"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"DOI":"10.1186\/s13256-026-06124-6","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:55:19Z","timestamp":1779389719000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic and management challenges of severe heart failure with reduced ejection fraction in a patient with extreme morbid obesity: a case report"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1640-8783","authenticated-orcid":false,"given":"Mafaz","family":"Mansoor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peyton","family":"Matt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Mohanty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srujitha","family":"Ravuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Varn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"6124_CR1","unstructured":"Epidemic: Report of a WHO Consultation on Obesity, Geneva, 3\u20135 June 1997. World Health Organization, Division of Noncommunicable Disease, Programme of Nutrition Family and Reproductive Health. 1998."},{"issue":"21","key":"6124_CR2","doi-asserted-by":"publisher","first-page":"E984","DOI":"10.1161\/CIR.0000000000000973","volume":"143","author":"American Heart Association Council on Lifestyle and Cardiometabolic Health","year":"2021","unstructured":"American Heart Association Council on Lifestyle and Cardiometabolic Health, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Stroke Council. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circ. 2021;143(21):E984\u20131010. https:\/\/doi.org\/10.1161\/CIR.0000000000000973.","journal-title":"Circ"},{"issue":"5","key":"6124_CR3","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.jacc.2022.11.024","volume":"81","author":"CJ Lavie","year":"2023","unstructured":"Lavie CJ, Virani SS, Laddu D, Arena R, Ortega FB, Blair SN. Challenges in cardiovascular evaluation and management of obese patients: JACC state-of-the-art review. J Am Coll Cardiol. 2023;81(5):490\u2013504. https:\/\/doi.org\/10.1016\/j.jacc.2022.11.024.","journal-title":"J Am Coll Cardiol"},{"issue":"25","key":"6124_CR4","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1056\/NEJMsa1909301","volume":"381","author":"ZJ Ward","year":"2019","unstructured":"Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381(25):2440\u201350. https:\/\/doi.org\/10.1056\/NEJMsa1909301.","journal-title":"N Engl J Med"},{"issue":"20","key":"6124_CR5","doi-asserted-by":"publisher","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","volume":"138","author":"K Thygesen","year":"2018","unstructured":"Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138(20):e618\u201351. https:\/\/doi.org\/10.1161\/CIR.0000000000000617.","journal-title":"Circulation"},{"key":"6124_CR6","unstructured":"ZOLL Medical Corporation completes launch of LifeVest wearable cardioverter defibrillator garment. Respiratory Therapy. Published March 19, 2014. Accessed May 19, 2026. https:\/\/respiratory-therapy.com\/products-treatment\/monitoring-treatment\/therapy-devices\/zoll-completes-launch-of-lifevest-wcd-garment."},{"issue":"7","key":"6124_CR7","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1016\/j.jacc.2016.11.069","volume":"69","author":"S Javaheri","year":"2017","unstructured":"Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, Malhotra A, Martinez-Garcia MA, Mehra R, Pack AI, Polotsky VY, Redline S, Somers VK. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841\u201358. https:\/\/doi.org\/10.1016\/j.jacc.2016.11.069.","journal-title":"J Am Coll Cardiol"},{"key":"6124_CR8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.124.072679","author":"MR Zile","year":"2024","unstructured":"Zile MR, Borlaug BA, Kramer CM, Baum SJ, Litwin SE, Menon V, Ou Y, SUMMIT Trial Study Group, et al. Effects of tirzepatide on the clinical trajectory of patients with heart failure, preserved ejection fraction, and obesity. Circulation. 2024. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.124.072679.","journal-title":"Circulation"},{"issue":"1","key":"6124_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000001035","volume":"6","author":"JC Grotberg","year":"2024","unstructured":"Grotberg JC, McDonald RK, Co IN. Point-of-care echocardiography in the difficult-to-image patient in the ICU: a narrative review. Crit Care Explor. 2024;6(1): e1035. https:\/\/doi.org\/10.1097\/CCE.0000000000001035.","journal-title":"Crit Care Explor"},{"issue":"2","key":"6124_CR10","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.rcl.2007.03.001","volume":"45","author":"RN Uppot","year":"2007","unstructured":"Uppot RN. Impact of obesity on radiology. Radiol Clin North Am. 2007;45(2):231\u201346. https:\/\/doi.org\/10.1016\/j.rcl.2007.03.001.","journal-title":"Radiol Clin North Am"},{"key":"6124_CR11","unstructured":"Philips. Azurion 7 C12 Image Guided Therapy System Specifications. Philips Healthcare; accessed May 19, 2026. https:\/\/www.philips.com\/c-dam\/b2bhc\/master\/landing-pages\/queen-alexandra\/specifications-of-our-igt-system-azurion-7-c12.pdf"},{"issue":"19","key":"6124_CR12","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1136\/heartjnl-2020-318811","volume":"108","author":"PM Haydock","year":"2022","unstructured":"Haydock PM, Flett AS. Management of heart failure with reduced ejection fraction. Heart. 2022;108(19):1571\u20139. https:\/\/doi.org\/10.1136\/heartjnl-2020-318811.","journal-title":"Heart"},{"issue":"2","key":"6124_CR13","doi-asserted-by":"publisher","first-page":"71","DOI":"10.2165\/11318100-000000000-00000","volume":"49","author":"MJ Hanley","year":"2010","unstructured":"Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet. 2010;49(2):71\u201387. https:\/\/doi.org\/10.2165\/11318100-000000000-00000.","journal-title":"Clin Pharmacokinet"},{"issue":"2","key":"6124_CR14","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.cjca.2014.10.025","volume":"31","author":"S Sankaralingam","year":"2015","unstructured":"Sankaralingam S, Kim RB, Padwal RS. The impact of obesity on the pharmacology of medications used for cardiovascular risk factor control. Can J Cardiol. 2015;31(2):167\u201376. https:\/\/doi.org\/10.1016\/j.cjca.2014.10.025.","journal-title":"Can J Cardiol"},{"issue":"1","key":"6124_CR15","first-page":"8","volume":"37","author":"M Kotlyar","year":"1999","unstructured":"Kotlyar M, Carson SW. Effects of obesity on the cytochrome P450 enzyme system. Int J Clin Pharmacol Ther. 1999;37(1):8\u201319.","journal-title":"Int J Clin Pharmacol Ther"},{"key":"6124_CR16","unstructured":"Huxel C, Raja A, Ollivierre-Lawrence MD. Loop Diuretics. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK546656."},{"key":"6124_CR17","doi-asserted-by":"crossref","unstructured":"Shank BR, Zimmerman DE. Demystifying drug dosing in obese patients. American Society of Health-System Pharmacists. 2015.","DOI":"10.37573\/9781585284825"},{"issue":"1089","key":"6124_CR18","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20170931","volume":"91","author":"RN Uppot","year":"2018","unstructured":"Uppot RN. Technical challenges of imaging & image-guided interventions in obese patients. Br J Radiol. 2018;91(1089): 20170931. https:\/\/doi.org\/10.1259\/bjr.20170931.","journal-title":"Br J Radiol"},{"issue":"4","key":"6124_CR19","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.cardfail.2019.10.001","volume":"26","author":"A Jaiswal","year":"2020","unstructured":"Jaiswal A, Truby LK, Chichra A, Jain R, Myers L, Patel N, Topkara VK. Impact of obesity on ventricular assist device outcomes. J Card Fail. 2020;26(4):287\u201397. https:\/\/doi.org\/10.1016\/j.cardfail.2019.10.001.","journal-title":"J Card Fail"},{"issue":"1","key":"6124_CR20","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ahj.2008.02.014","volume":"156","author":"A Oreopoulos","year":"2008","unstructured":"Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156(1):13\u201322. https:\/\/doi.org\/10.1016\/j.ahj.2008.02.014.","journal-title":"Am Heart J"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-06124-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06124-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06124-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:25:46Z","timestamp":1782303946000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-06124-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6124"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-06124-6","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"assertion":[{"value":"5 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was not required for this single case report, in accordance with the institutional policy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication was obtained from the patient. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"342"}}