ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1643983
This article is part of the Research TopicExploring Right-Left Heart Interactions in Cardiovascular Disease: Mechanisms and ImplicationsView all 3 articles
Right Heart Remodeling in End-Stage Pulmonary Arterial Hypertension and the Impact of Treatment Intensity
Provisionally accepted
Su-Gang Gong1
Qi-Hang Zhang2Jia-Yi Zhang3Qian Zhang1
RUI ZHANG1Hong-Ling - Qiu1
Ci-Jun Luo1Hui-Ting Li1
Wen-Hui Wu1
Ping Yuan1
Jing HE1
Jian Xu1
Jin-Ming Liu1
Qin-Hua Zhao1
Lan Wang1*- 1Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- 2the Second School of Clinical Medicine of Binzhou Medical University, Yantai, China
- 3Department of Respiratory & Critical Care Medicine, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
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Background: Research on the limits of compensatory right heart remodeling and the effects of pulmonary artery hypertension (PAH) targeted therapies on these mechanisms is limited. Method: Chest x-ray and echocardiographic data were collected from 143 deceased patients with PAH confirmed by right heart catheterization at their end-stage disease. Right heart remodeling was compared across different PAH treatment strategies. Results: This study of 143 deceased PAH patients (49 ± 17 years, 74.1% female) characterized right heart remodeling at the time of death. Mean cardiothoracic ratio (CTR), right atrial area (RAA) and mid-cavity RV linear dimension (RVD) measured by echocardiography were 0.61±0.09, 27 cm² (median 27, IQR 21–38), and 4.97±0.97 cm, respectively, with extremes of 0.88, 102 cm², and 7.50 cm. Intensive therapy resulted in larger CTR (0.63±0.08 vs. 0.60±0.09, p=0.016), RAA (30 [24–40] vs. 25 [19–34] cm², p=0.020), and RVD (5.30±0.97 vs. 4.65±0.85 cm, p<0.001) compared with non triple therapy. After adjusting for confounders, intensive therapy independently predicted increases in CTR (0.03, 95% CI 0.00-0.05, p=0.054), RAA (6.63 cm², 95% CI 1.46-11.80, p=0.013), and RVD (0.66 cm, 95% CI 0.34-0.98, p<0.001). Conclusion: These findings suggest that more aggressive PAH treatment is associated with greater right heart remodeling, highlighting the complex relationship between therapeutic intervention and disease progression in PAH patients.
Keywords: pulmonary arterial hypertension, death, Right heart remodeling, treatment intensity, targeted therapies
Received: 09 Jun 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Gong, Zhang, Zhang, Zhang, ZHANG, Qiu, Luo, Li, Wu, Yuan, HE, Xu, Liu, Zhao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lan Wang, Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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