{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:04:22Z","timestamp":1758931462247,"version":"3.44.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Research on the limits of compensatory right heart remodeling and the effects of pulmonary artery hypertension (PAH) targeted therapies on these mechanisms is limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study of 143 deceased PAH patients (49\u2009\u00b1\u200917 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\u2009\u00b1\u20090.09, 27\u2005cm<jats:sup>2<\/jats:sup> (median 27, IQR 21\u201338), and 4.97\u2009\u00b1\u20090.97\u2005cm, respectively, with extremes of 0.88, 102 cm<jats:sup>2<\/jats:sup>, and 7.50\u2005cm. Intensive therapy resulted in larger CTR (0.63\u2009\u00b1\u20090.08 vs. 0.60\u2009\u00b1\u20090.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.016), RAA (30 [(24\u201340)] vs. 25 [(19\u201334)]\u2005cm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic>\u2009=\u20090.020), and RVD (5.30\u2009\u00b1\u20090.97 vs. 4.65\u2009\u00b1\u20090.85\u2005cm, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) compared with non triple therapy. After adjusting for confounders, intensive therapy independently predicted increases in CTR (0.03, 95% CI 0.00-0.05, <jats:italic>p<\/jats:italic>\u2009=\u20090.054), RAA (6.63\u2005cm<jats:sup>2<\/jats:sup>, 95% CI 1.46-11.80, <jats:italic>p<\/jats:italic>\u2009=\u20090.013), and RVD (0.66\u2005cm, 95% CI 0.34-0.98, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1643983","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T05:30:57Z","timestamp":1758864657000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Right heart remodeling in 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