Modern possibilities of echocardiographic diagnosis in pulmonary arterial hypertension

Pulmonary Hypertension (PH) is a hemodynamic and pathophysiological condition characterized by an increase in mean pulmonary artery (PA) pressure by at least 20 mm Hg at rest, measured during right heart catheterization. One of the fastest and most accessible screening non-invasive diagnostic methods for assessing the likelihood of this condition is echocardiography, which is performed according to the standard transthoracic echocardiography protocol, focusing on visualizing and describing certain parameters that characterize function of heart right chambers. In patients with PH, structural changes in the heart right chambers can be observed, such as enlargement of the right atrium and right ventricle, changes in their geometric shape, thickening right ventricle wall, dilatation of the main PA and its branches, and the appearance of tricuspid regurgitation. Pulmonary artery pressure can be measured using either the velocity of the tricuspid regurgitant jet or the ratio of the time acceleration of flow in the outflow tract of the right ventricle to the ejection time (mean pressure in the PA), or the velocity of the pulmonary regurgitation jet (end-diastolic pressure in the PA). Classic parameters of the functional state of the right ventricle, as well as additional indicators of the evaluation of the right ventricular function, for example, the ratio of the amplitude of movement of the fibrous ring to systolic pressure in the PA, called the right ventriculoarterial coupling, should be evaluated only in expert centers providing care for patients with PH. Correct and timely diagnosis, clear dynamic monitoring of the patient’s condition play a crucial role in prescribing targeted treatment and predicting the disease course.