{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T19:22:42Z","timestamp":1793042562941,"version":"4.5.0"},"reference-count":93,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Obesity is a current pandemic that sets all affected individuals at risk of heart failure (HF), and the majority of them will develop the clinical syndrome of HF with preserved ejection fraction (HFpEF). The diagnosis of HFpEF is challenging as it is based on the detection of subtle functional and structural remodeling of the heart that leads to diastolic dysfunction with increased left ventricular (LV) filling pressures and raised natriuretic peptides (NPs). The accurate diagnosis of HFpEF is even more challenging in patients who are obese, since the echocardiographic imaging quality may be suboptimal, the parameters for the evaluation of cardiac structure are indexed to the body surface area (BSA) and thus may underestimate the severity of the remodeling, and the NPs in patients who are obese have a lower normal threshold. Moreover, patients who are obese are prone to atrial fibrillation (AF) and pulmonary hypertension (PH), making the evaluation of diastolic dysfunction more strenuous. The current review aims to offer insights on the accurate diagnosis of HFpEF in patients who are obese in different clinical scenarios\u2014patients who are obese in different clinical scenarios\u2014such as in sinus rhythm, in atrial fibrillation, and in the case of pulmonary hypertension\u2014by applying multimodality imaging and clinical diagnostic algorithms.<\/jats:p>","DOI":"10.3390\/jcm14061980","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T13:07:51Z","timestamp":1741957671000},"page":"1980","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Diagnosing Heart Failure with Preserved Ejection Fraction in Obese Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Marino","family":"Basha","sequence":"first","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evdoxia","family":"Stavropoulou","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Nikolaidou","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Dividis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouela","family":"Peteinidou","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1100-7430","authenticated-orcid":false,"given":"Panagiotis","family":"Tsioufis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, Ippokrateion Hospital, School of Medicine, National and Kapodistrial University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2543-1723","authenticated-orcid":false,"given":"Nikolaos","family":"Kamperidis","sequence":"additional","affiliation":[{"name":"Department of IBD, St. Mark\u2019s Hospital, Imperial College London, London HA1 3UJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Dimitriadis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, Ippokrateion Hospital, School of Medicine, National and Kapodistrial University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4658-5273","authenticated-orcid":false,"given":"Theodoros","family":"Karamitsos","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7491-6319","authenticated-orcid":false,"given":"George","family":"Giannakoulas","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7636-6725","authenticated-orcid":false,"given":"Konstantinos","family":"Tsioufis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, Ippokrateion Hospital, School of Medicine, National and Kapodistrial University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Ziakas","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-6718","authenticated-orcid":false,"given":"Vasileios","family":"Kamperidis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"ref_1","first-page":"s176","article-title":"Obesity: Definition, comorbidities, causes, and burden","volume":"22","author":"Apovian","year":"2016","journal-title":"Am. 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