Fourth, we provided evidence for five potential ECM-related biomarkers (NID1, C1QTNF1, CRTAC1, MEGF9 and SPARCL1) that were altered at both RV transcriptome and plasma proteome levels, which could classify compensated and decompensated RV and predict worse clinical outcomes in PAH participants. This evidence concerns the gene SPARCL1 and pulmonary arterial hypertension.