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The gold standard for assessing RV function and ventriculo\u2010arterial coupling is the construction of multi\u2010beat pressure\u2013volume (PV) loops. PV loops are technically challenging to acquire and not feasible for routine clinical use. Therefore, we aimed to map standard clinically available measurements to emergent PV loop phenotypes. One hundred and one patients with suspected PH underwent right heart catheterization (RHC) with exercise, multi\u2010beat PV loop measurement, and same\u2010day cardiac magnetic resonance imaging (CMR). We applied unsupervised <jats:italic>k<\/jats:italic>\u2010means clustering on 10 PV loop metrics to obtain three patient groups with unique RV functional phenotypes and times to clinical worsening. We integrated RHC and CMR measurements to train a random forest classifier that predicts the PV loop patient group with high discrimination (AUC\u2009=\u20090.93). The most informative variable for PV loop phenotype prediction was exercise mean pulmonary arterial pressure (mPAP). Distinct and clinically meaningful PV loop phenotypes exist that can be predicted using clinically accessible hemodynamic and RV\u2010centric measurements. Exercise mPAP may inform RV pressure\u2013volume relationships.<\/jats:p>","DOI":"10.1002\/pul2.70057","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:21:17Z","timestamp":1740118877000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An Unsupervised Approach to Derive Right Ventricular Pressure\u2013Volume Loop Phenotypes in Pulmonary Hypertension"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-6188","authenticated-orcid":false,"given":"Nikita","family":"Sivakumar","sequence":"first","affiliation":[{"name":"Institute for Computational Medicine Johns Hopkins University Baltimore Maryland USA"},{"name":"Department of Biomedical Engineering Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Zhang","sequence":"additional","affiliation":[{"name":"Institute 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