{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:47:02Z","timestamp":1789195622334,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dekanat der Medizinischen Fakult\u00e4t der Universit\u00e4t M\u00fcnster","award":["NUM-DIZ 01KX2121"],"award-info":[{"award-number":["NUM-DIZ 01KX2121"]}]},{"name":"BMBF","award":["NUM-DIZ 01KX2121"],"award-info":[{"award-number":["NUM-DIZ 01KX2121"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Heart failure (HF) with preserved ejection fraction (HFpEF) poses a diagnostic challenge, as it lacks a definitive hallmark beyond preserved left ventricular (LV)EF. This retrospective study aims to analyze the demographic and clinical characteristics of HFpEF patients within a real-world hospital cohort, with a particular focus on obesity and associated comorbidities. Methods: A total of 4019 patients who underwent echocardiography in 2020\u20132021 at a university hospital were screened for HFpEF. After stringent manual verification, 219 patients fulfilled the European Society of Cardiology (ESC) criteria for HFpEF. Demographic, clinical, and comorbidity data were analyzed and stratified by body mass index (BMI) categories and sex distribution. Results: Among the 219 HFpEF patients, 71.3% were classified as pre-obese or obese. Hypertension (93.6%), atrial fibrillation (74.3%), and obesity were common in the cohort, while sex distribution was balanced. Edema was more prevalent among obese patients, though HFpEF severity, as reflected by New York Heart Association (NYHA) classification and natriuretic peptide levels, did not differ significantly across BMI groups. Medical treatment patterns varied with BMI, with obese patients more frequently receiving diuretics, sodium-glucose cotransporter-2 inhibitors (SGLT-2i), and angiotensin receptor blockers (ARB). No significant differences were observed between male and female patients in terms of HFpEF severity markers. Conclusions: Obesity is a predominant feature in HFpEF and is associated with a high burden of comorbidities. However, sex does not appear to influence HFpEF severity in this cohort. These findings underscore the need for targeted therapeutic strategies in obese HFpEF patients.<\/jats:p>","DOI":"10.3390\/jcm14103348","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T09:13:38Z","timestamp":1747041218000},"page":"3348","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Obesity and Comorbidities in HFpEF: A Retrospective Cohort Analysis in a University Hospital Setting"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6421-8429","authenticated-orcid":false,"given":"Anastasia Janina","family":"Hobbach","sequence":"first","affiliation":[{"name":"Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Institute of Physiology II, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1557-8097","authenticated-orcid":false,"given":"Tobias Johannes","family":"Brix","sequence":"additional","affiliation":[{"name":"Institute of Medical Informatics, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Weyer-Elberich","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7206-3719","authenticated-orcid":false,"given":"Julian","family":"Varghese","sequence":"additional","affiliation":[{"name":"Institute of Medical Informatics, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Reinecke","sequence":"additional","affiliation":[{"name":"Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0801-3773","authenticated-orcid":false,"given":"Wolfgang Albrecht","family":"Linke","sequence":"additional","affiliation":[{"name":"Institute of Physiology II, University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3297","DOI":"10.1093\/eurheartj\/ehz641","article-title":"How to diagnose heart failure with preserved ejection fraction: The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)","volume":"40","author":"Pieske","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/ejhf.1741","article-title":"How to diagnose heart failure with preserved ejection fraction: The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)","volume":"22","author":"Pieske","year":"2020","journal-title":"Eur. J. Heart Fail"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1001\/jama.2015.17346","article-title":"Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: A randomized clinical trial","volume":"315","author":"Kitzman","year":"2016","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1056\/NEJMoa020245","article-title":"Obesity and the risk of heart failure","volume":"347","author":"Kenchaiah","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"eabd7064","DOI":"10.1126\/scitranslmed.abd7064","article-title":"Nicotinamide for the treatment of heart failure with preserved ejection fraction","volume":"13","author":"Abdellatif","year":"2021","journal-title":"Sci. Transl. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"120998","DOI":"10.1016\/j.lfs.2022.120998","article-title":"Acetylation and phosphorylation changes to cardiac proteins in experimental HFpEF due to metabolic risk reveal targets for treatment","volume":"309","author":"Koser","year":"2022","journal-title":"Life Sci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Basha, M., Stavropoulou, E., Nikolaidou, A., Dividis, G., Peteinidou, E., Tsioufis, P., Kamperidis, N., Dimitriadis, K., Karamitsos, T., and Giannakoulas, G. (2025). Diagnosing Heart Failure with Preserved Ejection Fraction in Obese Patients. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061980"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.118.034646","article-title":"A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction","volume":"138","author":"Reddy","year":"2018","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Theodorakis, N., Kreouzi, M., Hitas, C., Anagnostou, D., and Nikolaou, M. (2024). Adipokines and Cardiometabolic Heart Failure with Preserved Ejection Fraction: A State-of-the-Art Review. Diagnostics, 14.","DOI":"10.3390\/diagnostics14232677"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3434","DOI":"10.1093\/cvr\/cvac120","article-title":"Obesity and heart failure with preserved ejection fraction: New insights and pathophysiological targets","volume":"118","author":"Borlaug","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jacc.2013.02.092","article-title":"A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation","volume":"62","author":"Paulus","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Henry, J.A., Couch, L.S., and Rider, O.J. (2024). Myocardial metabolism in heart failure with preserved ejection fraction. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051195"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/HCO.0b013e32834b7faf","article-title":"Why are women more likely than men to develop heart failure with preserved ejection fraction?","volume":"26","author":"Scantlebury","year":"2011","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1161\/CIRCULATIONAHA.110.954388","article-title":"Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum","volume":"123","author":"Borlaug","year":"2011","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e003116","DOI":"10.1161\/CIRCHEARTFAILURE.115.003116","article-title":"Predicting heart failure with preserved and reduced ejection fraction: The international collaboration on heart failure subtypes","volume":"9","author":"Ho","year":"2016","journal-title":"Circ. Heart Fail"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"ehae666-949","DOI":"10.1093\/eurheartj\/ehae666.949","article-title":"ESC Heart Failure Association age-adjusted natriuretic peptide thresholds for a new diagnosis of heart failure: Diagnostic accuracy study","volume":"45","author":"Taylor","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4562","DOI":"10.1002\/ehf2.13612","article-title":"Diagnosis of patients with heart failure with preserved ejection fraction in primary care: Cohort study","volume":"8","author":"Forsyth","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/nrcardio.2017.65","article-title":"Epidemiology of heart failure with preserved ejection fraction","volume":"14","author":"Dunlay","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1177\/2047487320961980","article-title":"Role of gender, age and BMI in prognosis of heart failure","volume":"27","author":"Sciomer","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hobbach, A.J., Feld, J., Linke, W.A., Sindermann, J.R., Dr\u00f6ge, P., Ruhnke, T., G\u00fcnster, C., and Reinecke, H. (2024). BMI-stratified exploration of the \u2019obesity paradox\u2019: Heart failure perspectives from a large German insurance database. J. Clin. Med., 13.","DOI":"10.3390\/jcm13072086"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1038\/ijo.2013.203","article-title":"Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: A meta-analysis of individual patient data","volume":"38","author":"Padwal","year":"2014","journal-title":"Int. J. Obes."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Guo, L., Liu, X., Yu, P., and Zhu, W. (2022). The \u201cObesity Paradox\u201d in Patients With HFpEF With or Without Comorbid Atrial Fibrillation. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.743327"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chrysohoou, C., Konstantinou, K., and Tsioufis, K. (2024). The Role of NT-proBNP Levels in the Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction-It Is Not Always a Hide-and-Seek Game. J. Cardiovasc. Dev. Dis., 11.","DOI":"10.20944\/preprints202406.0270.v1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s11897-013-0155-7","article-title":"The Emerging Epidemic of Heart Failure with Preserved Ejection Fraction","volume":"10","author":"Oktay","year":"2013","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e003358","DOI":"10.1161\/CIRCHEARTFAILURE.116.003358","article-title":"Exploring new endpoints for patients with heart failure with preserved ejection fraction","volume":"9","author":"Butler","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1056\/NEJMoa2306963","article-title":"Semaglutide in patients with heart failure with preserved ejection fraction and obesity","volume":"389","author":"Kosiborod","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1056\/NEJMoa2313917","article-title":"STEP-HFpEF DM Trial Committees and Investigators. Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes","volume":"390","author":"Kosiborod","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1056\/NEJMoa2410027","article-title":"SUMMIT Trial Study Group. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity","volume":"392","author":"Packer","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Xu, L., and Zhu, D. (2024). GLP-1RA may have varying effects on cardiac structure in patients with ASCVD depending on BMI. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1355540"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e70063","DOI":"10.1111\/1753-0407.70063","article-title":"Sex Differences in the Efficacy of Glucagon-Like Peptide-1 Receptor Agonists for Weight Reduction: A Systematic Review and Meta-Analysis","volume":"17","author":"Yang","year":"2025","journal-title":"J. Diabetes"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3348\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:31:06Z","timestamp":1760031066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103348"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103348","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]}}}