Key result
In patients with pulmonary arterial hypertension, cardiac output significantly differed across BMI groups (p < 0.0001), and overweight patients demonstrated the best survival while underweight patients had the worst.
Why the study?
Obesity or underweight can complicate and aggravate symptoms and progression of right heart failure in pulmonary arterial hypertension, but the influence of different BMI categories on right heart function and outcome was unclear.
Does BMI status affect cardiac output and survival in patients with pulmonary arterial hypertension?
Cross-Sectional (n=755)
No
Does BMI status affect cardiac output and survival in patients with pulmonary arterial hypertension?
Effect estimate: R = 0.268
p-value: p=<0.0001
In patients with pulmonary arterial hypertension, higher BMI is associated with increased cardiac output and better survival, supporting the existence of an obesity paradox in this population.
BMI status may inform prognosis in PAH; leaves open whether targeted weight interventions improve right heart outcomes.
Background Obesity or underweight can complicate and aggravate symptoms and progression of right heart failure in patients with pulmonary arterial hypertension (PAH). This study investigates the influence of different body mass index (BMI) categories on right heart function and outcome in PAH patients. Methods In this cross-sectional study with survival follow-up (mean follow-up 3.1 ± 2.6 years, median 2.7 years), clinical measures such as WHO-functional class and invasively measured hemodynamic parameters at initial diagnosis of PAH were compared between different BMI groups. Results Out of 2055 data sets, 755 patients with PAH (62.5% female) were eligible for the study (65 ± 15 years, 44.9% idiopathic PAH, 64.8% WHO functional class III or IV). Out of them 15 patients (1.99%) were underweight (BMI < 18 kg/m 2 ), 248 (32.85%) patients had a normal weight (BMI 18.5–25 kg/m 2 ), 256 (33.91%) were overweight (BMI > 25 to 30 kg/m 2 ) and 236 patients (31.26%) were classified as obese (BMI > 30 kg/m 2 ). Worst survival was denoted for patients with BMI < 18.5 kg/m 2 , best survival for BMI > 25 to 30 kg/m 2 . Cardiac output (CO) significantly differed between BMI groups (p < 0.0001, R = 0.268) and sex. In multivariable age-adjusted survival analysis, BMI-status, sex and right ventricular function were identified as independent predictors of survival. Conclusions This is the first study to assess RV function with regard to BMI status and survival in PAH. The study underlines the importance of the parameter body weight in the clinical management of PAH patients. It provides important insights in the relations of BMI and CO and documented significant gender differences.
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Egenlauf et al. (2025) conducted a cross-sectional in Pulmonary arterial hypertension (PAH) (n=755). Body Mass Index (BMI) categories vs. Different BMI groups (underweight, normal, overweight, obese) was evaluated on Comparison of cardiac output (CO) between different BMI-groups (R = 0.268, p=<0.0001). In patients with pulmonary arterial hypertension, cardiac output significantly differed across BMI groups (p < 0.0001), and overweight patients demonstrated the best survival while underweight patients had the worst.
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