OBJECTIVE: To investigate the value of cardiac magnetic resonance (CMR) based right ventricle-pulmonary artery coupling (VAC) parameters in assessing risk stratification of connective tissue disease-related pulmonary hypertension (CTD-PH). METHODS: The clinical and CMR data of 62 patients with CTD-PH between June 2018 and April 2022 were retrospectively analyzed, and they were divided into low-risk low to moderate-risk group (n=39 patients) and moderate-high risk high-risk group (n=23 patients) according to risk stratification, and the patients' right and left ventricle-related volumetric，functional parameters, left ventricular tissue characterization parameters and VAC were statistically analyzed. The optimal model was sought to predict CTD- PH risk stratification. RESULTS: The differences in right ventricle-related volumes, functional parameters, and histological parameters of the right ventricular insertion were statistically significant in the two groups of patients with PH (P<0.05). The RVEDVI and VAC independent predictors, and the combination of RVEDVI and VAC had the best predictive accuracy (AUC=0.839, 95% CI: 0.735-0.944, P<0.001). CONCLUSIONS: Right ventricle-related volumes, functional parameters and tissue characterization parameters of the right ventricular insertion can be used to assess CTD-PH risk stratification; the combination of RVEDVI and VAC improves the accuracy of assessing risk stratification.