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The major determinant of symptoms and outcome in patients with pulmonary arterial hypertension (PAH) is right ventricle (RV) function and its coupling to the pulmonary circulation. To preserve a sufficient cardiac output, the RV adapts to increased afterload by increased contractility (homeometric adaptation) and, when this mechanism becomes exhausted, by increased volumes (heterometric adaptation).
Recent evidence1 has shown that PAH progression is characterised by changes in RV dimension and function (increased volumes and decreased ejection fraction), even in apparently stable patients, highlighting the importance of RV in determining the prognosis. The study from Goh and colleagues2 underscores the relevance of RV remodelling in PAH. The authors analysed a large cohort of 505 patients from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) registry. Cardiac magnetic resonance allowed to identify four different RV adaptation clusters according to its volume and mass. Patients with a favourable adaptive …
Contributors MD and RB drafted the work, revised it critically for important intellectual content and gave the final approval of the version to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.