American Society of Hirudotherapy

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.

Review published in European respiratory review : an official journal of the European Respiratory Society (2022)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical TrialsDrug DevelopmentBenza RL et al. · European respiratory review : an official journal of the European Respiratory Society, 2022

Abstract

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive diseases that can lead to right heart failure and death. Right ventricular dysfunction, hypertrophy and maladaptive remodelling are consequences of increased right ventricular (RV) afterload in PAH and CTEPH and are indicative of long-term outcomes. Because RV failure is the main cause of morbidity and mortality in PAH and CTEPH, successful treatments should lead to improvements in RV parameters. Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of PAH and inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy. This review examines the current evidence showing the effect of riociguat on the right ventricle, with particular focus on remodelling, function and structural parameters in preclinical models and patients with PAH or CTEPH.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsChronic DiseaseFamilial Primary Pulmonary HypertensionHeart VentriclesHumansHypertension, PulmonaryPulmonary Arterial HypertensionPulmonary EmbolismPyrazolesPyrimidinesSoluble Guanylyl Cyclase

Summary

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive diseases that can lead to right heart failure and death.

Why This Matters for Hirudotherapy

This review examines riociguat, a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH), summarizing evidence for its effects on the right ventricle, including remodelling, function, and structural parameters, in preclinical models and patients, given that right-ventricular failure is the main cause of morbidity and mortality in these diseases. The hirudotherapy link is indirect: CTEPH is a thrombosis-driven pulmonary vascular disease, so it sits within the broader thrombotic-disease landscape that motivates interest in leech-derived anticoagulant and antithrombotic compounds. This is a narrative review of a specific approved drug acting on the nitric-oxide/cGMP pathway, with no relation to leeches or hirudotherapy and no leech-relevant findings; it provides only disease-context background.

Citation

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.

Benza RL et al. · European respiratory review : an official journal of the European Respiratory Society, 2022

DOI

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

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