Achten Anouk, Peeters Lukas, Verkoulen Geert, Weerts Jerremy, Knackstedt Christian, Boerma Evert-Jan, van Empel Vanessa, Wijk Sandra Sanders-van
Department of Cardiology, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands.
Heart Fail Rev. 2025 Jun 23. doi: 10.1007/s10741-025-10540-z.
Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and is associated with a distinct pathophysiological phenotype. Individuals with obesity develop HFpEF on average a decade earlier than individuals without obesity. Despite this, systematic screening for HFpEF in individuals with obesity is not currently recommended in clinical guidelines. This review discusses the rationale for screening individuals with obesity for HFpEF, highlighting the rising prevalence of obesity-related HFpEF, its earlier onset, and its often under-recognized clinical presentation. We describe the specific pathophysiological mechanisms linking obesity to HFpEF, including inflammation, adipose tissue distribution, and hemodynamic alterations. Furthermore, we review the limitations of current diagnostic approaches in this population, including the interpretation of natriuretic peptides, echocardiographic challenges, and indexing pitfalls. Current and emerging screening tools (e.g., HFpEF-ABA score) are critically appraised, with a proposal for a stepwise screening and diagnostic pathway tailored to individuals with obesity. Given the high burden and early onset of HFpEF in people with obesity, screening strategies may enable earlier detection and timely intervention. Prospective studies are needed to determine the prevalence of (early) HFpEF in populations with obesity and to evaluate the effectiveness of structured screening approaches in clinical practice.
肥胖是射血分数保留的心力衰竭（HFpEF）的主要危险因素，且与一种独特的病理生理表型相关。肥胖个体发生HFpEF的时间平均比非肥胖个体早十年。尽管如此，目前临床指南并不推荐对肥胖个体进行HFpEF的系统筛查。本综述讨论了对肥胖个体进行HFpEF筛查的基本原理，强调了肥胖相关HFpEF的患病率上升、发病较早以及其临床表现常常未被充分认识。我们描述了将肥胖与HFpEF联系起来的具体病理生理机制，包括炎症、脂肪组织分布和血流动力学改变。此外，我们回顾了该人群当前诊断方法的局限性，包括利钠肽的解读、超声心动图检查的挑战以及指标计算的缺陷。对当前和新兴的筛查工具（如HFpEF-ABA评分）进行了批判性评估，并提出了针对肥胖个体的逐步筛查和诊断途径。鉴于肥胖人群中HFpEF的高负担和发病较早，筛查策略可能有助于早期发现和及时干预。需要进行前瞻性研究来确定肥胖人群中（早期）HFpEF的患病率，并评估结构化筛查方法在临床实践中的有效性。
