Background: Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the singular anatomy and structure of the right ventricle (RV) limit 2D analysis, and its regional 3D function has not been studied yet. Purpose: We examined the implications of regional 3D RV deformation on clinical condition and survival in adults with PH and healthy. Methods: We performed a prospective longitudinal cohort study recruiting 104 consecutive adult PH patients (58 female, 63±18 years)) and 34 healthy controls (43±14 years) between September 2014 and December 2015. Sixty-four patients (63.4%) were in NYHA functional class ≥III at baseline and 87 (83.7%) were on PH-targeted advanced therapies. 3D transthoracic RV echocardiographic sequences were acquired. Myocardial tracking was performed by a semi-automatic software. Output RV meshes included spatial correspondences. They were post-processed to extract local motion and deformation (area strain) and align the data temporally. Global and local statistics provided representative shape and deformation patterns for each subgroup of subjects. Results: The highest deformation was found in the RV lateral and inferior regions. In PH patients, RV global and regional motion as well as deformation (both area strain, circumferential and longitudinal strain) and global volume patterns were affected in all segments, as compared to healthy controls (p<0.001). Shape and deformation patterns were gradually deteriorated with the clinical condition. Over a median follow-up of 6.7 months [5.8-7.2], 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV area strain, TAPSE, 3D RV ejection fraction and end-diastolic volume were independent predictors of survival on multivariate COX survival analysis. Global RV area strain >-18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death (AUC 0.83 [0.74-0.90], p<0.001). Conclusion: RV shape and strain patterns are gradually deteriorated in PH patients and provide independent prognostic information in this population. Global RV area strain >-18% identifies high-risk PH patients.