Pulmonary hypertension (PH) is on the rise and doubled in prevalence in Western countries over the past decade. PH is associated with high morbidity and mortality, even at early stages. Recently updated guidelines now recognize a lower threshold for diagnosis of PH (>20 mmHg mPAP, >2 WU PVR) considering adverse effects caused by already mildly increased pulmonary artery pressure and resistance.

Precise phenotyping oh PH is critical; PH comprises heterogeneous subgroups, including precapillary, postcapillary, combined, and exercise PH. The most frequent cause remains left heart disease, particularly heart failure with preserved and reduced ejection fraction. However, also group 1 PH patients may present with left heart involvement “Pulmonary artery hypertension with comorbidities” oftentimes do not benefit from vasodilative PAH therapy. Furthermore, new pathways linking cardiomyopathy and PH are increasingly recognized even though they are less well understood.

The key challenge in managing pulmonary hypertension (PH) lies in achieving accurate diagnosis and precise characterization of its underlying pathophysiology. While right heart catheterization (RHC) remains the reference standard, non-invasive imaging offers the ability to detect subtle structural changes and provide a comprehensive assessment of biventricular function. Furthermore, whilst exercise-stress RHC is an invasive and tedious task to perform, non-invasive imaging may enhance clinical patient referrals.

Advanced modalities, including CMR, CT, and nuclear techniques, can now characterize right and left ventricular remodeling, quantify myocardial strain, assess pulmonary and systemic flow, and deliver detailed tissue characterization. These capabilities hold promise for earlier detection, improved classification, and more refined prognostication across the PH spectrum.

With this Research Topic, we aim to showcase innovative imaging strategies, address gaps in current phenotyping approaches, and explore how advanced cardiac imaging can drive personalized clinical management and inform trial design in PH.

This Research Topic welcomes original research, reviews, and perspectives focusing on advanced cardiac imaging in pulmonary hypertension. Contributions may address:
• Quantitative Echocardiography
• CMR or CT techniques
• Imaging-based risk stratification
• Integration of imaging with invasive or biomarker data
• The role of imaging in differentiating PH subtypes.

We also encourage submissions on novel applications such as machine learning in imaging analysis, exercise or stress imaging, and multimodality approaches to early detection and therapy monitoring. Both mechanistic insights and clinical translational studies are of interest. Manuscripts may range from methodological developments to multicenter cohort studies and will contribute to advancing the role of imaging in PH phenotyping.

Are you interested in contributing a manuscript to this Research Topic?

Advanced Cardiac Imaging for Phenotyping in Pulmonary Hypertension