Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of the American Society of Echocardiography Pub Date : 2025-03-01 DOI:10.1016/j.echo.2025.01.006

Monica Mukherjee MD, MPH, FASE, Chair , Lawrence G. Rudski MDCM, FASE, Co-Chair , Karima Addetia MD, FASE , Jonathan Afilalo MD, MSc , Michele D’Alto MD, PhD , Benjamin H. Freed MD, FASE , Lynsy B. Friend ACS, RCS, FASE , Luna Gargani MD, PhD , Julia Grapsa MD, PhD, FASE , Paul M. Hassoun MD , Lanqi Hua RDCS, FASE , Jiwon Kim MD, FASE , Valentina Mercurio MD, PhD , Rajan Saggar MD , Anton Vonk-Noordegraaf MD, PhD,

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Abstract

Right heart adaptation to pulmonary hypertension (PH) is a critical determinant of clinical outcomes, morbidity, and mortality in patients with or at risk for cardiopulmonary disease. The World Symposium on Pulmonary Hypertension recently redefined PH as a mean pulmonary arterial pressure >20 mm Hg, based on a wealth of epidemiologic evidence underscoring the significant impact of even mildly elevated mean pulmonary artery pressures on major adverse clinical events. The lowered diagnostic threshold for PH has renewed interest in echocardiography and its critical role in early detection and screening, refined hemodynamic evaluation, and longitudinal monitoring. However, the systematic assessment of the right heart remains inconsistent, largely due to the predominant focus on left heart evaluation, limited familiarity with right heart ultrasound techniques, and a paucity of reference data defining normal right heart size and function. A systematic, comprehensive ultrasound-based assessment of the right heart offers valuable diagnostic insights for in screening at-risk populations, PH classification, risk stratification, monitoring therapeutic response, and informing prognostication, thereby improving clinical outcomes.

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成人右心超声心动图评估指南及肺动脉高压的特殊考虑因素：美国超声心动图学会的建议

右心对肺动脉高压（PH）的适应是决定患有或有心血管疾病风险患者临床结局、发病率和死亡率的关键因素。最近，世界肺动脉高压研讨会将PH重新定义为平均肺动脉压20毫米汞柱，这是基于大量流行病学证据，强调即使是轻微的平均肺动脉压升高也会对主要的不良临床事件产生重大影响。超声心动图在早期发现和筛查、精细血流动力学评估和纵向监测方面的关键作用随着PH诊断阈值的降低而重新引起人们的兴趣。然而，对右心的系统评估仍然不一致，主要是由于主要关注左心评估，对右心超声技术的熟悉程度有限，以及缺乏定义正常右心大小和功能的参考数据。系统、全面的基于超声的右心评估为筛查高危人群、PH分类、风险分层、监测治疗反应和告知预后提供了有价值的诊断见解，从而改善了临床结果。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.