In HFpEF, patients suffer from stiffening of the left ventricle, which leads to elevated end-diastolic pressures and, consequently, inadequate filling of the ventricle. The consequences include fluid accumulation outside the blood vessels, subjective shortness of breath, a dry cough, or fatigue. HFpEF is the most common type of heart failure in older adults and primarily affects women. ⁽¹⁾ The disease is particularly common in obese/cardiometabolic patients. To date, researchers have assumed that obesity is the driving force behind this syndrome, although the underlying mechanisms that distinguish cardiometabolic HFpEF from obesity remain unclear.

A team led by Professor Gabriele Schiattarella of the German Heart Center at Charité (DHZC), guest researcher at the Max Delbrück Center and head of the research group “Translational Approaches to Heart Failure and Cardiometabolic Diseases,” took left ventricular biopsies from 19 severely obese HFpEF patients. Through “multi-omics” analyses of the tissue samples, the team discovered a very characteristic metabolic pattern. While lipid metabolism in the obese patients was nearly normal, glucose metabolism was disrupted, and certain metabolic byproducts accumulated in the heart tissue. Additionally, the heart tissue lacked energy.

The researchers concluded that HFpEF is not a consequence of obesity but a distinct disease, and that metabolic pathways represent potential targets for therapies.

Original publication:
Federico Capone, Karl-Philipp Rommel, Martin Forbes, Pauline Fahjen, Stefano Strocchi, Sebastian Rosch, Rongling Wang, David Bode, Natasha Nambiar, Tolga Eroglu, Leandro Santiago Padilla, Mario Luca Morieri, Luo Liu, Catherine Farrelly, Antonio Vacca, Guido Mastrobuoni, Simone Jung, Saskia A Diezel, Sarah V Liévano Contreras, Norbert Hübner, Philipp Mertins, Stefan Kempa, Philipp Lurz, Gabriele G Schiattarella, Integrated left ventricular multi-omics landscape of human cardiometabolic HFpEF, Cardiovascular Research, 2026;, cvag084, https://doi.org/10.1093/cvr/cvag084

Further information:
https://www.mdc-berlin.de/de/news/news/was-den-stoffwechsel-bei-hfpef-so-besonders-macht
(1) Dusik, F, Erdogan, D. et al. (n.d.). HFpEF-type heart failure. DocCheck Flexikon online accessed at: https://flexikon.doccheck.com/de/Herzinsuffizienz_vom_HFpEF-Typ#cite_note-zwei-1