The Role of Echocardiography in the Evaluation of Pulmonary Arterial Hypertension

Abstract

The evaluation of pulmonary arterial hypertension (PAH) requires a multimodality approach that combines invasive and noninvasive imaging studies to ensure accurate diagnosis and classification. Given the complexity of the hemodynamic relationships between the left heart, pulmonary circulation, and right heart, the diagnosis of PAH is often a challenging task. Right heart catheterization is the gold standard for diagnosis, providing the hemodynamic information that defines the disease. Nonetheless, echocardiography continues to be a valuable tool in the approach to the patient with suspected PAH. Echocardiographic assessment generates a wealth of information about the response of the right heart to elevated pulmonary pressures and provides essential diagnostic and prognostic data to the clinician. Numerous measurements can be used to identify alterations in right heart morphology, pressure, and function; although each variable in isolation may have little utility, meaningful information is revealed when multiple parameters are considered together. In this article, we will review the echocardiographic measurements employed in assessment of the right heart and seek to clarify the role of echocardiography in the diagnostic workup of PAH.

A novel scoring index by Doppler echocardiography for predicting severe pulmonary hypertension due to chronic lung diseases: a cross-sectional diagnostic accuracy study

“…Sometimes, patients are not willing to undergo RHC during follow-up because of its invasiveness and cost. However, as a PH-screening tool, PASP can be estimated by measuring the peak TRV on echocardiography, which continues to be recommended for early screening and assessment in patients with idiopathic PAH, chronic thromboembolism-associated PH, or connective tissue disease-associated PAH 20. However, PASP estimation is often inaccurate, especially in patients with CLD, and requires the presence of sufficient tricuspid regurgitation (TR), proper Doppler alignment, and optimal visualization of the regurgitant jet.…”

Transesophageal Echocardiographic Approach to a Patient with Suspected Pulmonary Hypertension in the Intraoperative Period

“…Chronic thromboembolic pulmonary hypertension 5 Pulmonary hypertension with unclear multifactorial mechanism 5.1…”

“…4 The accurate measurement of precapillary and postcapillary pulmonary pressures mandate the RHC, which forms the gold standard for the diagnosis of PH. 5 Despite recent advances in the catheterization procedures with minimal to no complications in the RHC, the invasive nature and the need of laboratory limit its use in evaluating these patients. With the advent of cardiac surgery in the early 1950s, many patients including children with various lesions undergo surgical correction, in which the accurate diagnosis of PH with its etiology and severity and the consequences of PH on right heart function play an important role in management.…”

“…4 Sleep disordered breathing 3. 5 Alveolar hypoventilation disorder 3. 6 Chronic exposure to high altitude 3.7…”

The Circulating MicroRNA-206 Level Predicts the Severity of Pulmonary Hypertension in Patients with Left Heart Diseases

“…PH is a hemodynamic definition, and invasive right heart catheterization (RHC) has been considered the gold standard for diagnosis. To date, however, conventional echocardiography continues to be used for the detection of PH [4, 5]. RHC is not routinely performed on patients with LHD in clinical practice, which impedes the early diagnosis of PH-LHD.…”