RV contraction is affected by both RV afterload and RV contractility.12 Riociguat has a dual mode of action that sensitizes sGC to endogenously produced nitric oxide (NO) and increases sGC activity in the absence of NO, thereby improving hemodynamics in PAH patients with impaired NO-sGC-cyclic guanosine monophosphate signaling. Here, SGCB is linked to pulmonary arterial hypertension.