AUTHOR=Gong Su-Gang , Zhang Qi-Hang , Zhang Jia-Yi , Zhang Qian , Zhang Rui , Qiu Hong-Ling , Luo Ci-Jun , Li Hui-Ting , Wu Wen-Hui , Yuan Ping , He Jing , Xu Jian , Liu Jin-Ming , Zhao Qin-Hua , Wang Lan 

TITLE=Right heart remodeling in end-stage pulmonary arterial hypertension and the impact of treatment intensity

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1643983

DOI=10.3389/fcvm.2025.1643983

ISSN=2297-055X

ABSTRACT=BackgroundResearch on the limits of compensatory right heart remodeling and the effects of pulmonary artery hypertension (PAH) targeted therapies on these mechanisms is limited.MethodChest 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.ResultsThis 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).ConclusionThese 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.