Pulmonary vascular disease & thromboembolism
Prevalence and Clinical Implications of Excess Adiposity in Group 1 Pulmonary Hypertension
Authors' conclusion
Excess adiposity is common in group 1 PH, occurring in 4 out of 5 patients by the more sensitive waist/height ratio, in contrast to only 2 out of 5 patients having obesity by traditional BMI criteria. Excess adiposity is associated with higher biventricular filling pressures, cardiac output demand, worse functional status and reduced survival.
Study context
- Population
- Patients with group 1 pulmonary hypertension (PH) recruited to PVDOMICS
- Participants
- 418 patients
- Exposure
- Obesity vs BMI<30 kg/m², stratified by insulin resistance (IR) status
- BMI≥30 kg/m²n = 158
- BMI<30 kg/m²n = 260reference
- Outcome
- Impact of excess adiposity vs IR on biventricular hemodynamic and functional reserve (dynamic PCWP and right atrial pressure responses, functional capacity)
Main finding
As reported in the abstract
| Group | Value | IR |
|---|---|---|
| BMI≥30 kg/m² | 38% | 94 [60%] |
| BMI<30 kg/m² | 62% | 74 [28%] |
Value
IR
- Excess adiposity by elevated waist/height ratio (n=375 with waist measurement)
- 287 (77%)
- Elevated waist circumference (n=375 with waist measurement)
- 214 (57%)
Observational data: associations, not effects.
Further findings
QoL, exercise capacity, left heart remodelling, resting/dynamic pulmonary capillary wedge pressure (PCWP), right atrial pressure, cardiac output, by obesity
- Worse QoL, exercise capacity and left heart remodelling, higher resting/dynamic PCWP, right atrial pressure and cardiac output with obesity
- P < 0.0001 for all
PCWP response with obesity, adjusted for IR
- IR-adjusted PCWP (obesity)
- +2.5 mm Hg (95% CI, +1.4 to +3.6); P<0.0001
PCWP response by adiposity indices and IR
- All adiposity indices consistently associated with PCWP response, but IR was not
- Similar associations of adiposity indices with higher right atrial pressure and cardiac output
Survival by visceral adiposity
- Body shape index, HR (worse survival)
- 2.01 (95% CI, 1.16-3.47); P=0.01
- Weight-adjusted waist index, HR (worse survival)
- 1.64 (95% CI, 1.10-2.46); P=0.01
Original publication
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