PVRI International Conference 2025: Embracing Heterogeneity

The 2025 PVRI International Conference was held in Rio de Janeiro, Brazil under the theme “Embracing Heterogeneity” over 4 days of insightful discussions on pulmonary hypertension (PH). The conference covered a diverse array of topics spanning basic science, translational research, and clinical observations from around the world. Attendees included experts from backgrounds ranging from early‐career investigators to senior scientists and clinicians and industry partners, representing 25 countries across 5 continents.

The opening day focused on the early diagnosis, risk stratification and treatment of pulmonary arterial hypertension (PAH). Prof. Rogerio Souza from the University of São Paolo kicked off the meeting by highlighting the challenges of PH care in Brazil, where geographic disparities and a predominance of schistosomiasis‐associated PAH pose unique obstacles [1]. Following this, updates from the 7th World Symposium on Pulmonary Hypertension in Barcelona, Spain outlined recent advancements and identified critical gaps in the field, framing much of the discussion over the next few days [2]. The opening session moved on to explore a broad spectrum of approaches that have advanced the early diagnosis of PAH including ‐omics technologies [3], advanced imaging and artificial intelligence [4, 5] and the use of preclinical models to improve clinical phenotyping. Risk stratification has emerged as a cornerstone in PAH management [6, 7] and several speakers provided insight into how risk scores have continued to evolve, including the incorporation of right ventricular phenotyping into these metrics. The first day closed with a dynamic round table discussion in which experts addressed the realities of implementing guidelines in low‐ and middle‐income countries—highlighting ongoing challenges and potential solutions. In addition, the importance of understanding global aspects, including PH epidemiology in understudied global areas emerged as important topics of research [8, 9].

Day two of the meeting focused on heterogeneity in PH associated with lung and heart diseases. From the vascular heterogeneity seen in these diseases to novel translational models, global experts set the stage for riveting discussions on approaches to understanding the complexities of these diseases. Advances in imaging to understand vascular heterogeneity and right ventricular function was a recurrent theme as many scientists have established innovative methodologies that can now work in harmony with translational approaches to improve our understanding of PH pathobiology [10]. Within lung diseases, heterogeneity was further emphasized given the stark differences in disease mechanisms and clinical phenotypes of PH related to fibrotic lung diseases or COPD [11, 12, 13]. A highlight of this session was a panel discussion in which experts discussed whether vascular abnormalities in chronic lung disease were a meaningful target in clinical medicine; bringing together basic scientists and clinical researchers, the panel deepened our understanding of the complexities of this question and identified many areas of focus for our scientific community.

The interplay between heart disease and pulmonary vascular dysfunction has remained a gap in our understanding of PH due to left‐sided heart disease. Several speakers presented updates on novel experimental models aimed at uncovering mechanisms underlying pulmonary vascular dysfunction in this context. The critical importance of right ventricular dysfunction was highlighted both as a downstream effect of pulmonary vascular disease and as a potential therapeutic target. The day concluded with a panel on managing these challenges in resource‐limited settings, where global experts shared their experiences and discussed how the PH community can improve access to high‐quality care worldwide.

The final day of the meeting focused on how insights from PH heterogeneity can inform strategies to improve patient outcomes. A key highlight was the emerging focus on the individual exposome and its contribution to PH heterogeneity. Discussions examined how factors such as drug and toxin exposure [14], infectious diseases [15], high‐altitude exposure [16], birth weight [17], microbiome [18] and environmental factors [19] may provoke distinct forms of PH and potentially serve as modifiable risk factors. Attention then turned to defining disease modification in the era of molecular‐targeted therapies. Speakers explored how to develop surrogates to quantify “reverse remodeling” and how to incorporate patient‐reported outcomes into the evolving paradigms of PH research. More novel tools, such as machine learning, large language processing, natural language processing to build large datasets of patients pose an exciting outlook that may help in patient risk stratification, optimize patient referral to PH centers and advance PH clinical trials. The final session focused on leveraging disease heterogeneity to inform clinical trials with speakers characterizing novel approaches including platform trials, digital trials and adaptive trial designs [20]. Special attention was given to incorporating global and pediatric perspectives, which pose unique challenges in the field.

A creative and interactive session modeled after “Dragon's Den” brought fresh energy to the final session. Participants pitched ideas for planned or fictional clinical trial designs, which were evaluated by a panel of “Dragons” and the audience. This engaging format encouraged collaboration and innovation, setting the stage for translating insights from heterogeneity in PH pathobiology into actionable strategies to improve patient outcomes.

Beyond scientific discourse, the conference prioritized networking and mentorship. Events such as the Early Career Catalyst Luncheon (Figure 1) and Women's Luncheon provided valuable opportunities for career development and collaboration. Poster sessions and evening receptions further fostered dialog and the exchange of ideas across disciplines and geographies. The 2025 PVRI International Conference underscored that PH is a heterogeneous disease that demands a multidisciplinary and collaborative approach. By embracing this diversity—whether in disease mechanisms, clinical phenotypes, or treatment responses—the global PH community is poised to advance care and improve outcomes for patients worldwide [21].

Figure 1.

(a) Successful early career catalyst Luncheon; (b) Organizing committee for the PVRI Conference 2025.

Author Contributions

Navneet Singh and Katarina Zeder wrote the Editorial and provided final approval.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.