Additionally, Obokata et al. found that patients with obesity-related HFpEF display more concentric LV remodeling, greater epicardial fat thickness, higher PAWP, RV dilation and dysfunction, elevated right atrial (RA) pressure, and increased total heart volume accompanied by lower NT-proBNP levels compared to non-obese HFpEF patients (32). Here, NPPB is linked to obesity due to melanocortin 4 receptor deficiency.