From Snapshot to Trajectory: The RV-3 Check for Pulmonary Arterial Hypertension Follow-up

Pulmonary arterial hypertension follow-up relies on composite clinical risk assessment, yet symptoms and functional markers may not always reflect right ventricular (RV) adaptation. We propose the RV-3 Check, a practical framework for serial RV assessment using three complementary domains: remodeling, systolic performance, and RV-pulmonary arterial coupling. Each domain is classified as improving, stable, worsening, or indeterminate, with overall RV direction assigned when at least two domains change concordantly. The framework is intended to identify clinically important discordance, particularly symptomatic improvement despite progressive RV deterioration, or persistent symptoms despite objective RV recovery. The RV-3 Check does not replace ESC/ERS risk stratification or invasive hemodynamics; rather, it serves as a structured confirmation tool that may prompt repeat imaging, cardiac magnetic resonance, or right-heart catheterization when findings are uncertain or management-changing. Prospective validation is needed before it can be used as an independent treatment algorithm.