Highlight
1. Right ventricular (RV) dysfunction in PH-HFpEF portends significantly poorer one-year clinical outcomes.
2. Advanced pulmonary vascular mechanics indicate segmental remodeling with increased arterial stiffness and abnormal wave reflections.
3. Four-dimensional flow MRI reveals perturbed blood flow and energy inefficiencies in left heart-pulmonary circulation.
4. Myocardial transcriptomics via long-read RNA sequencing highlights mitochondrial dysfunction and novel cardiac gene isoform alterations linked to RV failure.
