Pulmonary hypertension echocardiography or ultrasound
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Pulmonary Hypertension Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar.
Overview
Echocardiography may demonstrate enlargement of the right chambers with a thickened interventricular septum in patients with pulmonary hypertension. 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 function including:
- Pulmonary arterial pressure
- Tricuspid regurgitation
- Increased velocity of pulmonary valve regurgitation and short acceleration time of right ventricle ejection into the pulmonary artery
- Enlarged right heart chambers
- Abnormal shape and function (displacement) of interventricular septum
- Right ventricular wall hypertrophy
- Dilated main pulmonary artery
- Pericardial effusion
- Doppler echocardiographic index (Tei index or myocardial performance index) which is the sum of both isovolumetric contraction and relaxation intervals, divided by the ejection time
Shown below is a table summarizing the criteria to estimate the likelihood of the presence of PH based on echocardiography findings.
| 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 |
style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 30%" align=left|Class I, Level of evidence B | |
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:
- RVE: Right ventricular enlargement
- RVH: Right ventricular hypertrophy
- RAE: Right atrial enlargement
- TR: Tricuspid regurgitation
- PFO: Patent foramen ovale
- RVSP: Right ventricular systolic pressure
- SPAP: Systolic pulmonary artery pressure
- RVOT: Right ventricular outflow tract
- IVC: Inferior vena cava