[Pathophysiology of the Right Ventricle and its Pulmonary Vascular Interaction].

Authored by a consortium of experts from the German-speaking countries, this commentary on the 2024 World Symposium on Pulmonary Hypertension (WSPH) statement spotlights the updated definition of right-heart failure and its quantification through right-ventricular-pulmonary-artery (RV-PA) coupling indices. It reviews mechanistic advances in inflammation, fibrosis, metabolic dysregulation and sex-hormone modulation; elevates the right atrium as an early sentinel of RV load; refines criteria distinguishing adaptive from maladaptive RV remodelling using both invasive and non-invasive metrics; and analyses the haemodynamic and structural impact of emerging therapies - notably the activin-trap sotatercept - on the RV; the translational value of large-animal models and practical implications for multiparametric imaging. Overall, the commentary seeks to demonstrate how these insights can be integrated into routine diagnostic and monitoring strategies.