J Cardiovasc Imaging.  2020 Jan;28(1):1-9. 10.4250/jcvi.2019.0104.

Echocardiographic Screening Methods for Pulmonary Hypertension: A Practical Review

• Jang AY
• Shin MS

• KMID: 2468374
• DOI: http://doi.org/10.4250/jcvi.2019.0104

Abstract

Pulmonary hypertension (PH) is a debilitating condition defined as mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg. The importance of impaired right ventricular (RV) hemodynamics is increasingly being recognized in treatment of patients with PH. In World Health Organization Group 1 patients with pulmonary arterial hypertension, upfront combination therapy has recently been proposed to improve long-term survival. Also, the mPAP in Group 2 and 3 PH patients has been shown to be strongly associated with clinical outcomes. Thus, screening and monitoring of RV hemodynamics are becoming increasingly important. The gold standard for measuring RV hemodynamics is right heart catheterization (RHC). Although RHC can obtain the most accurate results, it is invasive, cumbersome to patients, and often associated with complications, making it unsuitable for a screening or monitoring modality. Echocardiography is useful in estimating hemodynamic parameters that can be obtained from RHC. Accordingly, the role of echocardiography in evaluating such patients with PH is becoming more important. In this article, we review practical echocardiographic methods in approximating RV hemodynamics for PH.

Keyword

Pulmonary hypertension; Mean pulmonary artery pressure; Echocardiography

MeSH Terms

Arterial Pressure
Cardiac Catheterization
Cardiac Catheters
Echocardiography*
Hemodynamics
Humans
Hydrogen-Ion Concentration
Hypertension
Hypertension, Pulmonary*
Mass Screening*
Methods*
World Health Organization

Figure

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  Figure 1 Echocardiographic images of methods for estimating mPAP. Estimation of mPAP using peak TR velocity (A); RVOTAT (B); peak and end PR velocity (C); and TR velocity TVI (D). mPAP: mean pulmonary artery pressure, PR: pulmonary regurgitation, RVOTAT: right ventricular outflow tract acceleration time, TR: tricuspid regurgitation, TVI: time velocity integral.

• 

  Figure 2 Echocardiographic methods for evaluating RV function. Assessment of MPA diameter (A); left ventricular eccentricity index (B); TAPSE (C); and RV fractional area change by measuring RVAd and RVAs for assessment of RV function (D). D1: axis parallel to interventricular septum, D2: axis perpendicular to interventricular septum, MPA: main pulmonary artery, RV: right ventricle, RVAd: RV area at diastole, RVAs: RV area at systole, TAPSE: tricuspid annular plane excursion.

• 

  Figure 3 Additional echocardiographic methods for evaluating RV function. RV function can be estimated by evaluating the RV dimensions (A); and RV pulsed tissue Doppler S wave (S') velocity (B). RV: right ventricular, RVD1: basal diameter of RV measured at the basal one-third of the RV, RVD2: RV diameter measured at the left ventricular papillary muscle level.

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