Right Ventricular Metabolic Adaptation to Afterload and Heterogeneous RV-Pulmonary Arterial Coupling in Pre-Capillary Pulmonary Hypertension: An FDG-PET/CMR Study

The authors aimed to investigate the relationship between right ventricular (RV) metabolic activity, pulmonary vascular load, and RV-pulmonary arterial (RV-PA) coupling in patients with pre-capillary pulmonary hypertension (PH). They found that increased pulmonary vascular resistance (PVR) is associated with enhanced RV glucose metabolism and impaired RV-PA coupling, suggesting that these metabolic changes may indicate early maladaptive adaptation to increased afterload before significant structural remodeling occurs. The study highlights the utility of integrated FDG-PET and CMR imaging in understanding RV adaptation mechanisms in PH.