El Hadj Othmane Taha, El Hadj Othmane Omar, Nizar Hisham
Cardiology, Heart Failure and Hypertension, OMC Healthcare, London, GBR.
Sixth Form, Harris Academy South Norwood, London, GBR.
Cureus. 2025 Mar 31;17(3):e81512. doi: 10.7759/cureus.81512. eCollection 2025 Mar.
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome with an obesity-related phenotype gaining prominence amid the global obesity epidemic. This review explores the distinct pathophysiological mechanisms, diagnostic challenges, and management strategies associated with obesity-induced HFpEF. Obesity contributes to HFpEF through several key mechanisms, including increased blood volume, myocardial hypertrophy and fibrosis, systemic inflammation, and metabolic dysregulation. These factors collectively exacerbate diastolic dysfunction and elevate left ventricular filling pressures, hallmark features of HFpEF. Diagnosing HFpEF in obese patients is particularly challenging due to overlapping comorbidities such as hypertension and diabetes, as well as the reduced reliability of traditional biomarkers such as N-terminal pro-B-type natriuretic peptide. Advanced imaging techniques are crucial in assessing diastolic dysfunction and myocardial remodeling. Managing obesity-related HFpEF requires a comprehensive approach. Lifestyle modifications, including weight loss and exercise, form the cornerstone of treatment, complemented by pharmacological therapies such as sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists. Optimizing comorbidity management is essential, while emerging therapies targeting inflammation, fibrosis, and metabolic dysfunction, alongside precision medicine approaches, offer promising future advancements. This review underscores the need for inclusive clinical trials and personalized treatment strategies to improve outcomes in obesity-related HFpEF. A deeper understanding of this phenotype is crucial for developing targeted interventions that enhance patient care and quality of life. Integrating these insights into clinical practice can help optimize diagnostic accuracy, refine therapeutic approaches, and guide risk stratification for better patient management.
射血分数保留的心力衰竭（HFpEF）是一种复杂的临床综合征，在全球肥胖流行的背景下，与肥胖相关的表型日益突出。本综述探讨了与肥胖诱导的HFpEF相关的独特病理生理机制、诊断挑战和管理策略。肥胖通过多种关键机制导致HFpEF，包括血容量增加、心肌肥厚和纤维化、全身炎症和代谢失调。这些因素共同加剧舒张功能障碍并升高左心室充盈压，这是HFpEF的标志性特征。由于高血压和糖尿病等合并症重叠，以及N末端B型利钠肽原等传统生物标志物的可靠性降低，在肥胖患者中诊断HFpEF特别具有挑战性。先进的成像技术对于评估舒张功能障碍和心肌重塑至关重要。管理与肥胖相关的HFpEF需要综合方法。生活方式的改变，包括减肥和运动，是治疗的基石，辅以钠-葡萄糖协同转运蛋白2抑制剂和盐皮质激素受体拮抗剂等药物治疗。优化合并症管理至关重要，而针对炎症、纤维化和代谢功能障碍的新兴疗法以及精准医学方法提供了有希望的未来进展。本综述强调需要进行包容性临床试验和个性化治疗策略，以改善肥胖相关HFpEF的预后。深入了解这种表型对于开发增强患者护理和生活质量的靶向干预措施至关重要。将这些见解整合到临床实践中有助于优化诊断准确性、完善治疗方法并指导风险分层，以更好地管理患者。
