Echocardiography in the Diagnosis of Pulmonary Hypertension: From Basic to Advanced

Clinical symptoms of pulmonary hypertension (PH) are non-specific and are caused by both high pressure in the pulmonary artery system and progressive right ventricular failure. Instrumental diagnosis of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is complex and requires using invasive and non-invasive imaging methods in the diagnostic algorithm, among which echocardiography (EchoCG) plays an important role. In the initial (screening) evaluation, EchoCG allows assessing the probability of the presence of pulmonary hypertension, the structure and function of the right and left heart chambers, and possible causes of increased pulmonary artery pressure. Echocardiographic imaging is continuously evolving, and measurements made with new methods, such as myocardial strain and 3D imaging, provide access to more information about the right heart chambers in an expert center for the management of patients with PAH and CTEPH. This review describes the parameters and their prognostic value for the diagnosis of PH during both primary (screening) EchoCG and examination in an expert center. Echocardiographic examination of patients with PAH and CTEPH is presented according to their routing stages. Extended EchoCG protocols for primary (screening) examination and examination in an expert center are presented.