Diagnostic accuracy of echocardiographic PASP in estimating pulmonary hypertension: comparison with right heart catheterization

Abstract Introduction Pulmonary hypertension (PH), a condition characterized by elevated pulmonary arterial pressure, requires accurate diagnosis for effective management. Right heart catheterization (RHC) remains the gold standard for PH diagnosis. However, echocardiographic estimation of pulmonary artery systolic pressure (PASP) is widely used as a noninvasive alternative. Although echocardiography offers accessibility and safety, the accuracy of PASP estimation in predicting PH as defined by invasive mean pulmonary artery pressure (mPAP) 20 mmHg is not fully established. Purpose To evaluate the correlation between echocardiographic PASP and invasively measured PASP, and to assess the diagnostic performance of PASP in identifying pulmonary hypertension. Methods Retrospective study. Patients referred for RHC and transthoracic echocardiography from a Pulmonary Hypertension specialty consult between August 2021 and May 2025 were included. Echocardiographic PASP was estimated using tricuspid regurgitation velocity and right atrial pressure. PH was defined as mPAP 20 mmHg on RHC. The correlation between PASP and mPAP was assessed by Pearson correlation coefficient. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of PASP for PH detection. We sought to analyze the maximum interval between transthoracic echocardiogram and right catheterization for which the PASP values maintained significant correlation through group analysis of 100 days intervals. Results A total of 176 cases were included. Table 1 summarizes baseline characteristics. A strong and statistically significant correlation was observed between PASP and invasively measured PASP (r=0.666, p0.01). ROC curve analysis showed that echocardiographic PASP had excellent discriminative ability for PH diagnosis, with an area under the curve (AUC) of 0.847. This suggests that noninvasive PASP measurement reliably identifies patients with PH, as defined by mPAP ≥20 mmHg. Our results show us that for a maximal interval of 500 days the PASP values maintain moderate and significant correlation (r=0.552, p0.05) and for a strong and significant correlation the maximum interval between measurements should be 400 days (r=0.846, p0.01) Conclusion Echocardiographic PASP demonstrated a strong correlation with invasively measured PASP and showed excellent accuracy in detecting pulmonary hypertension. With an AUC of 0.847, PASP estimation via echocardiography provides a valuable, noninvasive tool for the initial evaluation of suspected PH. While RHC remains indispensable for definitive diagnosis and hemodynamic characterization, echocardiography can serve as a practical screening method in clinical practice. These findings support the continued use of echocardiographic PASP as an accessible approach to PH assessment, particularly in settings where invasive testing is not immediately available.