BMI and Treatment Response in Patients With Pulmonary Arterial Hypertension

McCarthy, Breanne E.; McClelland, Robyn L.; Appleby, Dina; Moutchia, Jude; Minhas, Jasleen; Min, Jin Sik; Mazurek, Jeremy A.; Smith, K. Akaya; Fritz, J.S.; Pugliese, Steven C.; Urbanowicz, Ryan J.; Holmes, John H.; Palevsky, Harold I.; Kawut, Steven M.; Al‐Naamani, Nadine

doi:10.1016/j.chest.2022.02.041

Cited by 9 publications

(5 citation statements)

References 55 publications

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“…Finally, elevated BMI and obesity are associated with obesity hypoventilation syndrome and metabolic dysfunction associated pulmonary vascular remodeling, [26] which can elevate RAP and drive PAH. [27] The association between clinical factors and elevated pre-TIPS RAP provides a potential opportunity to enhance the recognition and risk stratification of subgroups of patients being considered for TIPS. We also assessed whether echocardiographic features or pre-TIPS diuretic use were associated with pre-TIPS RAP.…”

Section: Discussionmentioning

confidence: 99%

“…Native Americans have an increased risk for coronary artery disease25 and severe liver disease, although contributions to elevated pre-TIPS RAP are unknown. Finally, elevated BMI and obesity are associated with obesity hypoventilation syndrome and metabolic dysfunction associated pulmonary vascular remodeling,26 which can elevate RAP and drive PAH 27. The association between clinical factors and elevated pre-TIPS RAP provides a potential opportunity to enhance the recognition and risk stratification of subgroups of patients being considered for TIPS.…”

Section: Discussionmentioning

confidence: 99%

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The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study

et al. 2023

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Background and Aims: Single-center studies in patients undergoing TIPS suggest that elevated right atrial pressure (RAP) may influence survival. We assessed the impact of pre-TIPS RAP on outcomes using the Advancing Liver Therapeutic Approaches (ALTA) database. Approach and Results: Total 883 patients in ALTA multicenter TIPS database from 2010 to 2015 from 9 centers with measured pre-TIPS RAP were included. Primary outcome was mortality. Secondary outcomes were 48-hour post-TIPS complications, post-TIPS portal hypertension complications, and post-TIPS inpatient admission for heart failure. Adjusted Cox Proportional hazards and competing risk model with liver transplant as a competing risk were used to assess RAP association with mortality. Restricted cubic splines were used to model nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes. Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 95% CI, 1.01, 1.08, p=0.009) and composite 48-hour complications. RAP was a predictor of TIPS dysfunction with increased odds of post-90-day paracentesis in outpatient TIPS, hospital admissions for renal dysfunction, and heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. Conclusions: Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study

et al. 2023

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“…The literature suggests that obesity is associated with worse outcomes in patients with pulmonary arterial hypertension (PAH). A meta-analysis revealed that the response to treatment in patients with PAH was attenuated in those with increasing BMI [ 70 ] and health-related quality of life was worse in individuals with a raised BMI [ 71 ]. The effect of obesity on mortality in PAH remains unclear.…”

Section: Pulmonary Vascular Diseasementioning

confidence: 99%

Respiratory complications of obesity: from early changes to respiratory failure

Shah

Kaltsakas

2023

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Obesity is a significant and increasingly common cause of respiratory compromise. It causes a decrease in static and dynamic pulmonary volumes. The expiratory reserve volume is one of the first to be affected. Obesity is associated with reduced airflow, increased airway hyperresponsiveness, and an increased risk of developing pulmonary hypertension, pulmonary embolism, respiratory tract infections, obstructive sleep apnoea and obesity hypoventilation syndrome. The physiological changes caused by obesity will eventually lead to hypoxic or hypercapnic respiratory failure. The pathophysiology of these changes includes a physical load of adipose tissue on the respiratory system and a systemic inflammatory state. Weight loss has clear, well-defined benefits in improving respiratory and airway physiology in obese individuals.

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“…Some clinical studies suggest that obesity is associated with lower mortality in patients with precapillary pulmonary hypertension (PH) 1,2 . However other studies on patients with a mixed etiology of pulmonary arterial hypertension (PAH) or PH secondary to sleep apnea, suggest more severe disease in obese patients or increased mortality among young patients who are morbidly obese 3–5 . Weight loss, including bariatric surgery has been shown to improve pulmonary arterial pressures, symptoms, and exercise capacity in PAH patients 6 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 However other studies on patients with a mixed etiology of pulmonary arterial hypertension (PAH) or PH secondary to sleep apnea, suggest more severe disease in obese patients or increased mortality among young patients who are morbidly obese. [3][4][5] Weight loss, including bariatric surgery has been shown to improve pulmonary arterial pressures, symptoms, and exercise capacity in PAH patients. 6 The relationship between body mass index (BMI) and severity of PAH in patients with Group 1 heritable PAH (HPAH) and idiopathic PAH (IPAH) is unclear.…”

Section: Introductionmentioning

confidence: 99%

A pilot study to examine association of BMI with functional class and 6 min walk distance in idiopathic and heritable PAH: Possible association with estrogen metabolism

et al. 2022

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The hypothesis that a relationship exists between body mass index (BMI), functional class, and 6 min walk distance (6MWD) in Group 1-pulmonary arterial hypertension (PAH) was examined. Analysis of data from the UK National Cohort Study for heritable pulmonary arterial/idiopathic PAH suggests increased BMI is a predictor of worse functional class and shorter 6MWD; increased body-weight in mice and man may be associated with increased estrogen metabolism.

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BMI and Treatment Response in Patients With Pulmonary Arterial Hypertension

Cited by 9 publications

References 55 publications

The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study

The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study

Respiratory complications of obesity: from early changes to respiratory failure

A pilot study to examine association of BMI with functional class and 6 min walk distance in idiopathic and heritable PAH: Possible association with estrogen metabolism

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