There are moments in medicine when a new framework changes everything, not because the science is entirely new, but because it finally connects the dots we have long known were there. A landmark review published this spring in Heart Failure Reviews by researchers from the University of Oxford and Mayo Clinic Healthcare London is precisely such a moment.
The paper, “Reframing obesity-related HFpEF as a multiorgan syndrome: incretin-based therapies and imaging endpoints” — makes a compelling and evidence-grounded case that heart failure with preserved ejection fraction (HFpEF) driven by obesity is not a cardiac condition. It is, in truth, a whole-body cardiometabolic syndrome affecting the heart, liver, kidneys and adipose tissue simultaneously.
I am writing to share how this science directly informs what we are already doing here at Harley Street Longevity Club and Harley Weight Loss Clinic, and why I believe our approach represents some of the most forward-thinking metabolic care available in London today.
Obesity & Heart Failure: A Syndrome Hiding in Plain Sight
HFpEF — heart failure with a preserved pumping function — has long frustrated cardiologists because it does not respond to conventional heart failure drugs. The Oxford paper explains why: in obese patients, the problem originates not merely in the heart’s mechanics, but in a cascade of metabolic dysfunction spreading across multiple organs.
“Obesity-related HFpEF is best viewed as a multiorgan cardio–renal–hepatic–metabolic (CRHM) syndrome, rather than a purely cardiac disorder — one that inherently favours imaging-based phenotyping, because modern multimodality imaging can quantify cardiac, hepatic, adipose and renal involvement in parallel.”
Visceral fat accumulates not just under the skin but within and around vital organs — the heart’s pericardium, the liver, the kidneys, the skeletal muscle — triggering chronic inflammation, hormonal disruption, elevated filling pressures and progressive organ dysfunction. Breathlessness, fatigue and fluid retention follow, often attributed to the heart when the true culprit is systemic adiposity
Multi-Organ MRI: The Diagnostic Standard We Have Adopted
The Oxford paper argues that standard echocardiography is insufficient — particularly in obese patients where image quality is often poor and the scan cannot visualise extracardiac organ involvement. The authors call for a harmonised “heart–liver–fat” MRI protocol as the gold standard for evaluating and monitoring this condition.
At Harley Street Longevity Club and Harley Weight Loss Clinic, we are proud to be among the first clinics in London to adopt precisely this multi-organ MRI framework as part of our metabolic health assessments. A single integrated scanning session now allows us to evaluate:
This is not screening for the sake of it. These imaging endpoints map directly onto the biological mechanisms driving your symptoms — and they allow us to measure, precisely, whether treatment is reversing the damage.
Incretin-Based Therapy: The Right Tool for a Multiorgan Problem
The paper reviews the landmark clinical trials — STEP-HFpEF, STEP-HFpEF DM and SUMMIT — which demonstrate that GLP-1 receptor agonists (semaglutide) and dual GIP/GLP-1 agonists (tirzepatide) are transformative in obesity-related HFpEF. These are the same incretin-based therapies that underpin our weight loss programmes.
The evidence shows these treatments do not simply help patients lose weight. They act simultaneously across all affected organs:
At our clinic, we use these therapies not as a shortcut, but as a precision metabolic tool — deployed within a structured, medically supervised programme, with multi-organ MRI imaging to objectively track benefit and guide dosing decisions.
What This Means for You as a Member
If you carry excess weight — particularly central or visceral adiposity — you may have been told your heart function is “normal” on standard tests. The science now tells us that this can be misleading. The true risk may already be accumulating silently in your pericardial fat, your liver, your kidneys.
Our multi-organ MRI assessment, combined with our medically supervised incretin-based weight loss programme, offers you a genuine opportunity to identify this syndrome early and reverse it — not manage it.
I invite you to speak with one of our physicians about whether a comprehensive metabolic MRI assessment is appropriate for you. This is exactly the kind of proactive, evidence-led medicine that Harley Street Longevity Club was founded to deliver
With warm regards and commitment to your long-term health,
Dr Saima Ajaz
