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Exercise cardiovascular magnetic resonance (CMR) assessment of right ventricular (RV) size and function could help identify patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) who have poorer prognosis, even when resting CMR appears reassuring. The study, published in the European Heart Journal – Cardiovascular Imaging, included 50 patients with SSc-PAH, categorized as intermediate risk. The patients underwent CMR-augmented cardiopulmonary exercise testing. Most had normal CMR-defined resting measures of RV size and function. Nine patients died during a median follow-up of 2.1 years. Peak exercise RV indexed end-systolic volume (RVESVi) was the only CMR metric to predict prognosis on stepwise Cox regression analysis. Low-intermediate risk patients with peak RVESVi less than 39 mL/m² had significantly better survival than all other combinations of low-/high-intermediate risk status and peak RVESVi measurements. Ventilatory efficiency and resting oxygen consumption (VO₂) were predictive of mortality, but not peak VO₂, peak cardiac output, or peak tissue oxygen extraction.