What is the clinical evidence from this study?

Study design: Cohort. Population: Pulmonary arterial hypertension (PAH) (n=234). Intervention: Right atrial adverse remodeling (RAAR) vs. Without RAAR. Primary outcome: Composite of heart failure-related readmission, all-cause mortality, and lung transplantation (HR 2.571, 95% CI 1.331-4.966, p=0.005).

What does this research mean for the field?

Right atrial adverse remodeling at 1-year follow-up is a significant predictor of poor event-free survival in patients with pulmonary arterial hypertension and improves the prognostic accuracy of established ESC and COMPERA risk models. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the prognostic value of right atrial adverse remodeling following 1 year of targeted therapy in patients with pulmonary arterial hypertension.

September 14, 2026Pulmonary CirculationOpen Access

Prognostic Value of Right Atrial Adverse Remodeling in Patients With Pulmonary Arterial Hypertension

Q: What are the key findings of this study?

Right atrial adverse remodeling at 1-year follow-up was independently associated with an increased risk of heart failure readmission, mortality, or lung transplantation in patients with pulmonary arterial hypertension (HR 2.571).

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Key result

Right atrial adverse remodeling at 1 year is linked to ~157% higher composite events in PAH.

HR 2.571
95% CI 1.331-4.966
P=0.005
n=234

Why the study?

Does right atrial adverse remodeling (RAAR) predict adverse clinical outcomes in patients with pulmonary arterial hypertension?

Key Points

To assess the prognostic value of right atrial adverse remodeling following 1 year of targeted therapy in patients with pulmonary arterial hypertension.
Prospectively enrolled 240 patients diagnosed with pulmonary arterial hypertension between June 2013 and June 2024, of whom 234 completed 1-year echocardiographic follow-up with a median overall follow-up of 37.5 months (interquartile range: 23.3–57.5 months).
Defined right atrial adverse remodeling by receiver operating characteristic curve analysis as a right atrial diameter decrease of < 13% or any increase from baseline at 1 year.
Tracked a primary composite endpoint of heart failure-related readmission, all-cause mortality, and lung transplantation.
Right atrial adverse remodeling occurred in 168 patients (71.8%), with baseline right atrial diameter identified as its sole independent predictor (OR 0.941, p = 0.012).
Right atrial adverse remodeling was associated with significantly worse event-free survival across both low-risk (log-rank p = 0.037) and intermediate-/high-risk strata (log-rank p < 0.001).
Incorporating right atrial adverse remodeling significantly improved the prognostic accuracy of the ESC risk model (χ2: 18.08–21.83) and the three-strata COMPERA model (χ2: 22.65–28.04).

Study Design

Type

Cohort (n=234)

Blinding

Echocardiographers blinded to clinical outcomes

Multicenter

Structured PICO

Does right atrial adverse remodeling (RAAR) predict adverse clinical outcomes in patients with pulmonary arterial hypertension?

Population

234 adult patients with pulmonary arterial hypertension receiving targeted therapy, followed for a median of 37.5 months.

Exposure

Targeted therapy for PAH with assessment of right atrial adverse remodeling (RAAR) at 1-year follow-up echocardiography.

Comparator

Patients without right atrial adverse remodeling (RAAR).

Outcome

Composite of heart failure-related readmission, all-cause mortality, and lung transplantation.composite

Main Result

Hazard Ratio: 2.571 (95% CI 1.331–4.966)

p-value: p=0.005

Right atrial adverse remodeling (RAAR) at 1-year follow-up is an independent predictor of adverse clinical outcomes in patients with pulmonary arterial hypertension, providing incremental prognostic value over established risk models.

Limitations

Single-center prospective study with a limited sample size
Included only patients with PAH, predominantly CHD-PAH with substantial within-group heterogeneity
Relatively young cohort mainly in WHO FC II–III, which may restrict generalizability
Treatment patterns may not fully reflect current guideline-directed care
Changes in serological markers, exercise capacity, and hemodynamics during follow-up were not analyzed in relation to RAAR
RA remodeling was assessed solely by RAD on 2D ECHO, which may not fully reflect its structural and functional complexity

Implication

RAAR may identify higher-risk PAH patients on therapy; extends ESC/COMPERA models yet requires prospective validation.

Abstract

Assessment of right atrial (RA) structure helps monitor right heart (RH) function, critical for prognosis in pulmonary arterial hypertension (PAH). This study aims to assess the prognostic value of RA adverse remodeling (RAAR) with targeted therapy in PAH. Patients diagnosed with PAH between June 2013 and June 2024 were prospectively recruited. Right atrial reverse remodeling (RAAR) was defined by the relative change in right atrial diameter (RAD) on 1‐year follow‐up echocardiography (ECHO). RAAR was defined as a RAD decrease of < 13% or any increase from baseline, as determined by receiver operating characteristic curve analysis. The primary composite endpoint included heart failure‐related readmission, all‐cause mortality, and lung transplantation. Of 240 patients enrolled, 234 completed 1‐year follow‐up, with a median follow‐up duration of 37.5 months (interquartile range: 23.3–57.5 months). RAAR was observed in 168 patients (71.8%), and baseline RAD was its sole independent predictor (OR 0.941, p = 0.012). RAAR was associated with significantly poorer event‐free survival in both the low‐risk group (log‐rank p = 0.037) and the intermediate‐/high‐risk group (log‐rank p < 0.001). Adding RAAR improved the ESC model (χ 2 : 18.08–21.83) and the three‐strata COMPERA model (χ 2 : 22.65–28.04). These findings suggest that RAAR is a key indicator for evaluating prognosis in PAH patients, holding promise for reflecting treatment response and predicting clinical outcomes in PAH.

Discussion

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Published by Pulmonary Circulation · CC BY-NC

Cite This Study

Zhao et al. (2026) conducted a cohort in Pulmonary arterial hypertension (PAH) (n=234). Right atrial adverse remodeling (RAAR) vs. Without RAAR was evaluated on Composite of heart failure-related readmission, all-cause mortality, and lung transplantation (HR 2.571, 95% CI 1.331-4.966, p=0.005). Right atrial adverse remodeling at 1-year follow-up was independently associated with an increased risk of heart failure readmission, mortality, or lung transplantation in patients with pulmonary arterial hypertension (HR 2.571).

synapsesocial.com/papers/6aa7afef79e9260bc85aac70 https://doi.org/10.1002/pul2.70397

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Implication

RAAR may identify higher-risk PAH patients on therapy; extends ESC/COMPERA models yet requires prospective validation.

Prognostic Value of Right Atrial Adverse Remodeling in Patients With Pulmonary Arterial Hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Prognostic Value of Right Atrial Adverse Remodeling in Patients With Pulmonary Arterial Hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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