Figure 3.

Body composition and heart failure. Proposed mechanisms driving obesity to heart failure (HF) and to the obesity paradox once HF is diagnosed. The dark blue arrows indicate the potential detrimental effects of body composition components (fat mass and lean mass) on cardiac function and eventually HF development. The light blue arrows indicate the potential mechanisms by which body composition improves cardiorespiratory fitness (CRF). Reprinted from Mayo Clin Proc., 92(2), Carbone S, Lavie CJ, Arena R. Obesity and heart failure: focus on the obesity paradox, 266–279, Copyright (2017), with permission from Elsevier.⁹

Abbreviations: IL, interleukin; LV, left ventricular; LVH, LV hypertrophy; SVR, systemic vascular resistance; TNF-α, tumor necrosis factor α.