Obesity is a significant risk factor for heart failure (HF), particularly heart failure with preserved ejection fraction (HFpEF). The condition causes morphological and functional alterations in the cardiovascular system, leading to various cardiovascular diseases, including atrial fibrillation, coronary artery disease, sudden cardiac death, and HF. Pathogenetic mechanisms include left ventricular remodeling, epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi-imaging modalities, such as echocardiography, are crucial for diagnosing subclinical systolic dysfunction associated with obesity. Weight loss is a primary therapeutic intervention, and sodium-glucose co-transporter-2 inhibitors (SGLT2) have been introduced as a novel tool for managing HF. The review discusses recent studies on the pathogenesis, diagnosis, and management of obesity-related HF, emphasizing the importance of a multi-imaging approach and therapeutic strategies tailored to the specific needs of obese patients.Obesity is a significant risk factor for heart failure (HF), particularly heart failure with preserved ejection fraction (HFpEF). The condition causes morphological and functional alterations in the cardiovascular system, leading to various cardiovascular diseases, including atrial fibrillation, coronary artery disease, sudden cardiac death, and HF. Pathogenetic mechanisms include left ventricular remodeling, epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi-imaging modalities, such as echocardiography, are crucial for diagnosing subclinical systolic dysfunction associated with obesity. Weight loss is a primary therapeutic intervention, and sodium-glucose co-transporter-2 inhibitors (SGLT2) have been introduced as a novel tool for managing HF. The review discusses recent studies on the pathogenesis, diagnosis, and management of obesity-related HF, emphasizing the importance of a multi-imaging approach and therapeutic strategies tailored to the specific needs of obese patients.