Semaglutide is a long-acting GLP-1ra that reduced 14.9% of body weight in patients with obesity or overweight without diabetes for 68 weeks treatment [23] or 13% in patients with obesity and HFpEF for 52 weeks treatment [50] Despite all GLP1-ra had demonstrated an improvement of cardiometabolic parameters (glucose, lipids, etc....) and cardiac CT was not performed in our patients, a randomized clinical trial showed an efficient reduction of epicardial fat after semaglutide therapy [51]. This evidence concerns the gene GLP1R and obesity due to melanocortin 4 receptor deficiency.