Heartbeat: right ventricular remodelling in pulmonary hypertension

In patients with pulmonary arterial hypertension (PAH), Goh and colleagues1 hypothesised that adaptation of the right ventricle (RV) in response to chronic pressure overload would predict clinical outcome. Cardiac magnetic resonance (CMR) imaging in 505 patients in the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) was used to classify the pattern of RV remodelling. At a median of 4.85 years follow-up, 51% of patients died. Prognosis was best in the 181 patients with a relatively normal RV size and wall thickness (low-volume-low-mass) and most of these patients continued to have low-volume-low-mass on guideline-based medical therapy. In contrast the 74 patients with a high-volume-low-mass RV had the worst prognosis and were unlikely to show improvement in RV morphology even on treatment (figure 1). © 2022 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.