Why the study?
Echocardiography suggests but does not diagnose pulmonary hypertension, requiring invasive hemodynamic monitoring to establish the diagnosis, identify the involved vascular territory, and guide appropriate therapy.
This review highlights the necessity of invasive hemodynamic monitoring for accurate diagnosis and classification of pulmonary hypertension, and cautions against the use of PAH-specific therapies in patients with left heart disease.
Echocardiographic PH suspicion warrants invasive confirmation before therapy decisions; leaves open optimal non-invasive diagnostic thresholds.
The finding of pulmonary hypertension (PH) by echocardiography is common and of concern. However, echocardiography is just a suggestive and non-diagnostic assessment of PH. When direct involvement of pulmonary circulation is suspected, invasive hemodynamic monitoring is recommended to establish the diagnosis. This assessent provides, in addition to the diagnostic confirmation, the correct identification of the vascular territory predominantly involved (arterial pulmonary or postcapillary). Treatment with specific medication for PH (phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostacyclin analogues) has been proven effective in patients with pulmonary arterial hypertension, but its use in patients with PH due to left heart disease can even be damaging. In this review, we discuss the diagnosis criteria, how etiological investigation should be carried out, the clinical classification and, finally, the therapeutic recommendations for PH.
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Calderaro et al. (2019) studied this question.
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