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Pulmonary hypertension echocardiography or ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar; José Eduardo Riceto Loyola Junior, M.D.[2]

Overview

Echocardiography may demonstrate right ventricular or atrial enlargement with a thickened interventricular septum in patients with pulmonary hypertension, decreased right ventricular function, or hypertrophy. Pulmonary artery systolic pressure can also be estimated using echocardiography. Right ventricular afterload may be suggested by a leftward septal displacement during systole. Pericardial effusions and diminished left ventricular cavity typically portend a dismal prognosis.

Echocardiography

Once pulmonary hypertension is suspected in a patient, a transthoracic echocardiogram should be done to assess right heart functions including:

Echocardiographic assessment

  • The most important initial parameter for evaluation using echocardiography is the pulmonary artery systolic pressure (PASP), which can be estimated using echocardiography.
  • Its evaluation is limited when an accurate tricuspid regurgitation envelope can’t be measured.
  • Signs of right ventricular or atrial enlargement, decreased right ventricular function or hypertrophy are more important than PASP because they indicate a more severe disease with cardiac compromise.
  • Leftward deviation of the interventricular septum, the “D sign” is correlated with poorer prognosis.[1]

Shown below is a table summarizing the criteria to estimate the likelihood of the presence of PH based on echocardiography findings.[2]

Likelihood of the Presence of PH Criteria Class, Level of Evidence
Unlikely Tricuspid regurgitation velocity ≤2.8 m/s
AND
Pulmonary artery systolic pressure ≤36 mmHg
AND
Absence of other echocardiography findings suggestive of PH		 Class I, Level of Evidence B
Possible Tricuspid regurgitation velocity ≤2.8 m/s
AND
Pulmonary artery systolic pressure 37-50 mmHg
AND
Presence of other echocardiography findings suggestive of PH		 Class IIa, Level of evidence C
Possible Tricuspid regurgitation velocity 2.9-3,4 m/s
AND
Pulmonary artery systolic pressure ≤36 mmHg
AND
Presence or absence of other echocardiography findings suggestive of PH		 Class IIa, Level of Evidence C
Likely Tricuspid regurgitation velocity >3.4 m/s
AND
Pulmonary artery systolic pressure >50 mmHg
AND
Presence or absence of other echocardiography findings suggestive of PH		 Class I, Level of evidence B

Echocardiography plays a pivotal role in the diagnosis of PH due to left heart failure. Echocardiographic findings characteristic of left ventricular diastolic dysfunction are:[3]

Video showing Top 10 echocardiographic findings in moderate to severe pulmonary hypertension

Disclaimer: Adapted from Billy Cathey RDCS:Pulmonary hypertension 2D findings: {{#ev:youtube|3yOdNyTH07g}} Abbreviations:

References

  1. ↑ Poch D, Mandel J (2021). “Pulmonary Hypertension”. Ann Intern Med. 174 (4): ITC49–ITC64. doi:10.7326/AITC202104200. PMID 33844574 Check |pmid= value (help).
  2. ↑ Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA; et al. (2009). “Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)”. Eur Heart J. 30 (20): 2493–537. doi:10.1093/eurheartj/ehp297. PMID 19713419.
  3. ↑ Hoeper MM, Barberà JA, Channick RN, Hassoun PM, Lang IM, Manes A; et al. (2009). “Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension”. J Am Coll Cardiol. 54 (1 Suppl): S85–96. doi:10.1016/j.jacc.2009.04.008. PMID 19555862.

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