The right ventricle and its stress response is perhaps the most important arbiter of survival in patients with pulmonary hypertension of many causes. The physiology of the cardiopulmonary unit and definition of right heart failure proposed in the 2018 World Symposium on Pulmonary Hypertension have proven useful constructs in subsequent years. Here, we review updated knowledge of basic mechanisms that drive right ventricular function in health and disease, and which may be useful for therapeutic intervention in the future. We further contextualise new knowledge on assessment of right ventricular function with a focus on metrics readily available to clinicians and updated understanding of the roles of the right atrium and tricuspid regurgitation. Typical right ventricular phenotypes in relevant forms of pulmonary vascular disease are reviewed and recent studies of pharmacological interventions on chronic right ventricular failure are discussed. Finally, unanswered questions and future directions are proposed.

右心室及其应激反应可能是多种原因导致的肺动脉高压患者生存的最重要因素。2018 年世界肺动脉高压研讨会上提出的心肺单元生理学和右心衰竭的定义在随后的几年中已被证明是有用的结构。在这里，我们回顾了在健康和疾病中驱动右心室功能的基本机制的最新知识，这些机制可能有助于未来的治疗干预。我们进一步将有关右心室功能评估的新知识置于背景中，重点是临床医生容易获得的指标，并更新了对右心房和三尖瓣反流作用的理解。综述了相关肺血管疾病的典型右心室表型，并讨论了最近对慢性右心室衰竭药物干预的研究。最后，提出了未回答的问题和未来的方向。