{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:33:02Z","timestamp":1792794782837,"version":"4.5.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Although obesity and insulin resistance (IR) are established risk factors for left heart dysfunction, their clinical impact in group 1 pulmonary hypertension (PH) remains unclear. We sought to determine the impact of excess adiposity versus IR on biventricular hemodynamic and functional reserve in group 1 PH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Homeostasis model of insulin resistance and adiposity indices (body mass index [BMI], fat mass, waist circumference) were measured among group 1 patients with PH recruited to PVDOMICS (Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics). Functional capacity, and dynamic pulmonary capillary wedge pressure (PCWP) and right atrial pressure responses were compared stratified by obesity (BMI\u226530 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and IR status (HOMA-IR\u22652.6) using repeated-measure mixed models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among patients with group 1 PH (n=418), 158 (38%) had BMI\u226530 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (94 [60%] of whom had IR), and 260 (62%) had BMI&lt;30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (74 [28%] of whom had IR). Among those with waist circumference measurement (n=375), 287 (77%) had excess adiposity by elevated waist\/height ratio, with 214 (57%) having elevated waist circumference. Patients with obesity had worse quality of life, exercise capacity and left heart remodeling, along with higher resting\/dynamic PCWP, right atrial pressure and cardiac output (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001 for all). Higher PCWP response with obesity persisted after adjusting for IR (IR-adjusted PCWP+2.5 mm\u2009Hg [95% CI, +1.4 to +3.6];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001). All adiposity indices were consistently associated with PCWP response, but IR was not. Similar associations were observed between adiposity indices with higher right atrial pressure and cardiac output. Greater visceral adiposity as measured by body shape index (hazard ratio, 2.01 [95% CI, 1.16\u20133.47];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.01) or weight-adjusted waist index (hazard ratio, 1.64 [95% CI, 1.10\u20132.46];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.01) was associated with worse survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>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. These data support trials of adipose-reducing therapies in patients with group 1 PH and excess adiposity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.125.013591","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:00:40Z","timestamp":1764756040000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence and Clinical Implications of Excess Adiposity in Group 1 Pulmonary Hypertension"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5322-0902","authenticated-orcid":true,"given":"Yogesh N.V.","family":"Reddy","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.N.V.R., R.P.F., B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4128-3978","authenticated-orcid":true,"given":"Robert P.","family":"Frantz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.N.V.R., R.P.F., B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2755-5845","authenticated-orcid":true,"given":"Anna R.","family":"Hemnes","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN (A.R.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0601-4975","authenticated-orcid":true,"given":"Paul M.","family":"Hassoun","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (P.M.H., S.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5751-9415","authenticated-orcid":true,"given":"Evelyn M.","family":"Horn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Perkin Heart Failure Center, Weill Cornell Medicine, New York, NY (E.M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0598-8882","authenticated-orcid":true,"given":"Jane A.","family":"Leopold","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA (J.A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Rischard","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson (F.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4849-214X","authenticated-orcid":true,"given":"Erika B.","family":"Rosenzweig","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Medicine, Columbia University, New York, NY (E.B.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8242-8339","authenticated-orcid":true,"given":"Nicholas S.","family":"Hill","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, MA (N.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5202-9065","authenticated-orcid":true,"given":"Serpil C.","family":"Erzurum","sequence":"additional","affiliation":[{"name":"Lerner Research Institute (S.C.E.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8876-5045","authenticated-orcid":true,"given":"Gerald J.","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences (G.J.B.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0156-6757","authenticated-orcid":true,"given":"J. Emanuel","family":"Finet","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (J.E.F., C.L.J., W.H.W.T.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8610-0533","authenticated-orcid":true,"given":"Christine L.","family":"Jellis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine (J.E.F., C.L.J., W.H.W.T.), Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3188-7209","authenticated-orcid":true,"given":"Stephen C.","family":"Mathai","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD (P.M.H., S.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-735X","authenticated-orcid":true,"given":"W.H. 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