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Body weight significantly influenced right heart function and survival in pulmonary arterial hypertension, with both extremes of BMI linked to poorer outcomes.   

A study published in June 2025 issue of Clinical Research in Cardiology explored how extremes in body weight, including obesity and underweight status, may negatively influence symptoms and progression of right heart failure in pulmonary arterial hypertension (PAH).  

Researchers conducted a retrospective study to examine how various body mass index (BMI) categories affected right heart function and clinical outcomes in individuals with PAH.  

They assessed individuals with PAH, with a mean follow-up of 3.1 ± 2.6 years and a median of 2.7 years. Clinical variables, including World Health Organization functional class (WHO-FC) and invasively obtained hemodynamic data at the time of diagnosis, were compared across different BMI categories.  

The results showed that out of 2,055 datasets, 755 individuals with PAH were eligible (62.5% female; mean age 65 ± 15 years; 44.9% idiopathic PAH; 64.8% in WHO-FC III or IV). Among them, 15 (1.99%) were underweight [BMI < 18 kg/m²], 248 (32.85%) had normal weight [BMI 18.5–25 kg/m²], 256 (33.91%) were overweight [BMI > 25 to 30 kg/m²], and 236 (31.26%) were obese [BMI > 30 kg/m²]. The poorest survival was seen in those with [BMI < 18.5 kg/m²], while the best outcomes occurred in those with [BMI > 25 to 30 kg/m²]. Cardiac output (CO) varied significantly by BMI and sex [P< 0.0001, R = 0.268]. Multivariable survival analysis adjusted for age identified BMI, sex, and right ventricular (RV) function as independent survival predictors.  

Investigators concluded that BMI was a significant clinical factor linked to RV function, CO, survival, and sex-related differences in individuals with PAH. 

Source: link.springer.com/article/10.1007/s00392-025-02682-9