Pathophysiologie des rechten Ventrikels und seine pulmonal-vaskuläre Interaktion

Zusammenfassung

Dieser Kommentar zum WSPH-Statement 2024 wurde von Expert*innen des deutschsprachigen Raumes verfasst. Schwerpunkte sind die aktuelle Definition der Rechtsherzinsuffizienz und ihre Abbildung durch RV-PA-Kopplungsparameter; pathomechanistische Fortschritte zu Entzündung, Fibrose, metabolischer Dysfunktion und geschlechtsspezifischen Hormoneinflüssen; die Rolle des rechten Vorhofs als Frühmarker der RV-Belastung; Kriterien für adaptive versus maladaptive RV-Remodellierung mit invasiven und nicht-invasiven Messgrößen; Auswirkungen neuer Therapien – insbesondere des Activin-Fallenproteins Sotatercept – auf Hämodynamik und RV-Struktur; der translationale Wert großer Tiermodelle sowie praxisnahe Konsequenzen für multiparametrische Bildgebung. Insgesamt soll diese Kommentierung zeigen, wie sich diese Erkenntnisse in alltagsrelevante Diagnose- und Monitoringstrategien überführen lassen.

Abstract

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.

Schlüsselwörter

Rechtsherzinsuffizienz - rechtsventrikuläre pulmonalarterielle Kopplung - Maladaptation

Keywords

right heart insufficiency - right ventricular pulmonary arterial coupling - maladaptation

^* geteilte Erstautorenschaft

Publication History

Article published online:
06 October 2025

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