Which findings on a Doppler echocardiography suggest pulmonary arterial hypertension (PAH)?

Updated: Apr 25, 2018
  • Author: Kristin E Schwab, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Doppler echocardiography is the most reliable noninvasive method of estimating pulmonary arterial pressure.

Tricuspid regurgitation is usually present in patients with pulmonary arterial hypertension (PAH), which facilitates measurement of pulmonary arterial pressure with the modified Bernoulli equation. The efficacy of Doppler echocardiography depends on the ability to locate the tricuspid regurgitant jet. Furthermore, acoustic windows may be limited in patients who have other diseases (eg, chronic obstructive pulmonary disease [COPD]) or in those who are obese.

Tricuspid regurgitation is generally detected in more than 90% of patients with severe pulmonary hypertension, and a correlation of greater than 95% is observed when the pressure is measured by means of catheterization. Doppler echocardiography is a useful noninvasive test for long-term follow-up.

Visual inspection of the shape of the right ventricular Doppler flow velocity envelope provides insight into the hemodynamic basis of PAH. [21] Midsystolic notch was associated with the most severe pulmonary vascular disease and right-sided heart dysfunction.

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