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We sought to study trans\u2010right ventricular (RV) metabolite gradients to elucidate potential molecular pathways operant among individuals with obesity and pulmonary hypertension. In this study, 38 individuals with obesity (mean age 58\u2009years, 68% women, average BMI 36.6\u2009kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ) underwent invasive right heart catheterization. Multi\u2010site blood sampling from the superior vena cava and pulmonary artery was performed to assess trans\u2010RV gradients, with targeted metabolite profiling using liquid chromatography\u2010mass spectrometry. We found 56 metabolites with significant trans\u2010RV gradients (FDR\n                    <jats:italic>q<\/jats:italic>\n                    \u2009&lt;\u20090.05), including intermediates of fatty acid oxidation, the tricarboxylic acid cycle, and nucleotide metabolism. Further, trans\u2010RV gradients in lipid and purine metabolism were associated with BMI and related cardiometabolic traits, such as waist circumference, insulin resistance, and serum lipids. Finally, differential levels of bile acids, intermediates of lipid peroxidation, and nucleotide metabolism across the RV were associated with pulmonary hypertension. In conclusion, trans\u2010RV metabolite gradients among individuals with obesity reveal alterations in metabolites representative of molecular pathways such as fatty acid oxidation, and others correlated with cardiometabolic traits and\/or pulmonary hypertension, including orotic acid, bile acids, and acylcarnitines.\n                  <\/jats:p>","DOI":"10.14814\/phy2.70323","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T01:37:43Z","timestamp":1747273063000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Trans\u2010right ventricle metabolite gradients in obesity highlight multiple metabolic pathways"],"prefix":"10.14814","volume":"13","author":[{"given":"Hanna M.","family":"Knauss","sequence":"first","affiliation":[{"name":"Division of Cardiology Beth Israel Deaconess Medical Center  Boston Massachusetts 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