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The obesity paradox and discrepancy between peak oxygen consumption and heart failure prognosis--it's all in the fat.

The authors present the case of an obese patient with advanced heart failure that demonstrates the paradox between obesity and heart failure prognosis. In addition, the authors discuss the rationale for the correction of cardiopulmonary stress data (used as predictors of survival and listing for cardiac transplantation) for lean weight (as opposed to total body weight), a consideration that may be particularly important in obese patients with a high percentage of body fat.