The role of echocardiography in the diagnostic work-up of pulmonary hypertension

Pulmonary hypertension (PH) is a disorder with sometimes a challenging diagnosis, which can be made only by right heart catheterization. The role of echocardiography in the work-up of these patients is manifold. Its main contribution is in the assessment of the presence of PH in the setting of a clinical suspicion and thus it serves as a gatekeeper to avoid unnecessary invasive catheterizations. In this regard, estimation of pulmonary artery pressure is a central but not the only component that should be pursued, since there are many other additional echocardiographic features that can help the clinician to estimate the probability of the presence of PH more accurately and to fully assess its pathophysiological consequences. In addition, echocardiography can offer invaluable insight into right ventricular size and function, which is the cardiac chamber that is mainly affected by the disease and finally, it can provide important clues about the cause of PH and mainly help identify patients with pulmonary venous hypertension, in which treatment is entirely different from patients with precapillary hypertension. This review summarizes the echocardiographic findings commonly observed in patients with PH and focuses on important features that allow the clinician to exploit the full potential of this modality when assessing these patients.