Anne-Marie Koop

10 Nowadays, heart failure affects more than 26 million people worldwide and is an important cause of morbidity and mortality. 1 Heart failure can result from various pathologic conditions, including sustained abnormal loading conditions due to valve abnormalities, septal defects or pulmonary hypertension. 2 Deterioration of left ventricular (LV) function has long been considered as the leading determining factor of well-being and survival in this group of patients. However, over the last decades, it has become increasingly clear that in patients with congenital heart defects 3 , pulmonary hypertension 3,4 and LV disease 5–9 , the right ventricular (RV) function is an important determinant of outcome. RV adaptation is a continuum from beneficial to pathologic remodelling, accompanied with metabolic and hemodynamic changes, which eventually contributes to clinical right sided heart failure. In the last years, scientific statements have been published regarding RV disease, aiming at better guidance to clinical management. 10,11 These statements report that interventions targeting RV failure have not been well investigated yet and RV specific therapies are still unavailable. After years of ignoring the relevance of the RV in cardiac disease, it is time to rapidly expand the knowledge of RV adaptation to pathological conditions. This will improve the identification of patients affected by RV disease and optimize their treatment options.