P ulmonary hypertension (PH) is a hemodynamic and pathophysiological state defined as increased mean pulmonary artery pressure ≥25 mm Hg at rest (assessed by right heart catheterization [RHC]).1 PH can be precapillary (pulmonary wedge pressure ≤15 mm Hg, normal or reduced cardiac output) where the changes occur in the pulmonary arterial circulation or postcapillary (pulmonary wedge pressure >15 mm Hg) where the left ventricle (LV) or the mitral valve is likely to be involved. Clinical Perspective on p 114In precapillary PH, increased pressure in the pulmonary arteries overloads the right ventricle (RV), causing hypertrophy and failure. [2][3][4] Most measures that predict survival in PH relate directly to RV function (eg, right atrial pressure and cardiac index) or correlate with measures related to RV function (eg, exercise capacity and functional class [FC]).5-7 Until recently, little was known about the RV; however, improved imaging techniques have allowed prognostic factors beyond the traditional variables of 6-minute walk distance (6MWD) and FC to be studied to identify factors more directly linked to RV function.During the past 2 decades, several treatments targeting the pathophysiological mechanisms of pulmonary arterial hypertension (PAH) have been introduced.

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