Advances in Diagnosis and Management of Pulmonary Arterial Hypertension: A Systematic Review

Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disorder characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance, ultimately resulting in right ventricular failure and premature mortality. Despite its rarity, PAH remains associated with significant morbidity and mortality due to delayed diagnosis and rapid disease progression. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched for studies published between January 2015 and December 2025. Search terms included "Pulmonary arterial hypertension," "Diagnosis," "Right heart catheterization," "Biomarkers," "Cardiac MRI," "Combination therapy," "Sotatercept," and "Management." Original research articles, randomized controlled trials, systematic reviews, meta-analyses, and international clinical practice guidelines published in English were included. Following screening and eligibility assessment, 72 studies fulfilled the inclusion criteria. Recent evidence demonstrates significant improvements in early diagnosis through multimodal imaging, cardiac magnetic resonance imaging, artificial intelligence-assisted echocardiography, circulating biomarkers, genetic screening, and refined hemodynamic assessment. Earlier diagnosis, individualized risk assessment, and precision medicine approaches are expected to further optimize long-term outcomes.