show Abstracthide AbstractIn this study, we performed molecular phenotyping of RV remodeling, by transcriptome analysis of RV tissue obtained from 40 patients. The unsupervised clustering analysis identified “early" and "late" subgroups within compensated and decompensated states, characterized by the expression of distinct signaling pathways, and different circulating levels of several ECM proteins in decompensated RV subgroups. Our study provides a resource for the subphenotyping of RV states, the identification of state-specific biomarkers, and potential therapeutic targets for RV dysfunction. Overall design: RNA sequencing was performed for RV tissues obtained from human patients clinically categorized as compensated RV (n=14), decompensated RV (n=13) and donor controls (n=13). Followed by additional clustering labels, A to E. Cluster A represent Normal group (n=24), Cluster B represent compensated RV group (n=4), Cluster C represent severe hypertrophic RV group (n=3), Cluster D represent early decompensated group (n=5), and Cluster E represent late decompensated group (n=4).