Before we dive further into the 2025 ASE Right Heart Guidelines, let’s zoom out for the big picture understanding of pulmonary hypertension in echo.

This blog gives you the “why” behind all the echo measurements — what pulmonary hypertension (PH) really means, how it changes the right heart, and how echocardiography fits into diagnosis, prognosis, and follow-up.

1. What Is Pulmonary Hypertension (PH)?

Definition

Pulmonary Hypertension (PH) is defined as a mean pulmonary arterial pressure (mPAP) > 20 mm Hg measured by right-heart catheterization (RHC).

This threshold was lowered from 25 mm Hg after studies showed that even mildly elevated pressures are linked to increased mortality.

Pathophysiology Simplified

1. Increased Pulmonary Vascular Resistance (PVR) → harder for the RV to eject blood.
2. RV Pressure Overload → RV wall thickens (adaptive remodeling).
3. RV Dilatation & Failure → the RV can no longer keep up, leading to systemic venous congestion.

2. The Five Groups of Pulmonary Hypertension (PH) – Simplified.

3. Why the Right Heart Matters

• The right ventricle (RV) determines outcome in PH.
• Patients don’t die from high pulmonary pressures — they die from RV failure.
• RV performance metrics (TAPSE, S′, FAC, strain) are independent predictors of survival.

4. How Pulmonary Hypertension Is Diagnosed

* Pre-capillary PH starts in the lungs — the right ventricle pushes against high resistance.”

* Post-capillary PH starts in the left heart — the pressure backs up through the pulmonary veins into the lungs.

5. The Role of Echocardiography

Echocardiography provides a non-invasive window into right-heart structure, function, and hemodynamics.

The 2025 ASE Guidelines organize this into three pillars:

• Structure – RA, RV, and PA size, wall thickness
• Function – TAPSE, S′, FAC, strain, 3D RVEF
• Hemodynamics – TR velocity, RAP/IVC, RVOT AccT

When interpreted together, they tell the story of adaptation vs failure.

6. Prognostic Power of Echo Findings

7. Common Pitfalls

8. Putting It All Together

Before measuring, ask yourself:

• What’s the likely cause of PH?
• Is the RV adapting or failing?
• Which echo metrics will best tell that story?

This foundation sets up the deep-dive into future blogs.

Now that we understand why pulmonary hypertension matters and how it impacts the right heart, we will continue to explore how the 2025 ASE Guidelines redefine its assessment.

• Structure: How the right heart remodels
• Function: How the RV pumps under pressure
• Hemodynamics: How to quantify what the pressure means

Previous Related Blogs

From Diagnosis to Prognosis: How the 2025 ASE Right Heart Guidelines Redefine Echo

2025 ASE Right Heart New Severity Gradings: 5 Big Echo Changes You Need to Know

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