A recent scientific statement from the American Heart Association, published in the journal Circulation, places greater emphasis on right ventricular function in both research and clinical care for pulmonary hypertension (PH). The publication summarizes the current state of knowledge on molecular, metabolic, and imaging approaches to characterizing right heart failure. Several researchers from the German Center for Lung Research (DZL) contributed to the statement.
At its core is the recognition that right ventricular dysfunction is a key prognostic factor in pulmonary hypertension and significantly contributes to disease burden and mortality. As the disease progresses, increased vascular resistance in the lungs leads to chronic pressure overload of the right heart. While this is initially compensated by adaptive mechanisms, it ultimately results in structural and functional changes that culminate in right heart failure.
The statement provides a detailed description of the transition from initially adaptive hypertrophy to a maladaptive remodeling phase, characterized by dilation, fibrosis, and impaired coupling between the right ventricle and the pulmonary vasculature. This so-called “RV–pulmonary arterial uncoupling” is considered a critical step in disease progression.
Particular attention is given to emerging research approaches that go beyond pressure overload alone. These include molecular and metabolic mechanisms such as inflammatory processes, altered cell communication, and disruptions in myocardial energy supply. At the same time, advanced imaging techniques and biomarkers are becoming increasingly important for the earlier and more precise detection of pathological changes.
The authors also emphasize the potential of new therapeutic strategies. Innovative agents, particularly those targeting specific signaling pathways, may in the future not only reduce the burden on the pulmonary vasculature but also directly improve right ventricular function.
Overall, the statement underscores a paradigm shift: the right heart is increasingly being recognized as an independent therapeutic target. Greater consideration of its function could help enable more personalized treatment approaches and sustainably improve the prognosis of patients with pulmonary hypertension.
Original publication:
Pullamsetti, S. et al., Advanced molecular, metabolic, and imaging approaches to characterizing right ventricular failure: A scientific statement from the American Heart Association. Circulation. 2026;153:e000–e000. doi: 10.1161/CIR.0000000000001422
