Anjali Vaidya, MD, is the director of the Advanced Pulmonary Hypertension, Right Heart Failure & CTEPH Program and the Pulmonary Hypertension Fellowship at Temple University Hospital and a professor of medicine at Temple University

Anjali Vaidya, MD, FACC, FASE, FACP

PAH rarely belongs to a single specialty. The panel describes the team-based model behind effective care and reviews how four complementary treatment pathways now give clinicians a broad toolbox.

PAH Care Teams, Unmet Needs, and the Four Treatment Pathways

This episode, "PAH Care Teams, Unmet Needs, and the Four Treatment Pathways," features the panel examining who belongs on the care team and what the treatment toolbox now contains.

Dr. McLaughlin asks how a multidisciplinary team supports patients with PAH. Dr. Kim explains that pulmonary hypertension does not sit within one subspecialty, so cardiologists and pulmonologists must work together to sort out the cause of shortness of breath. PAH is rare and seldom the first diagnosis considered. Right heart catheterization is required, rheumatologists refer many patients with connective tissue disease, and primary care providers remain essential because patients are living longer and still need general health maintenance.

Dr. McLaughlin adds that no PAH center is complete without nurses, nurse practitioners, and research coordinators, and she says she could not do her job if her nurses left tomorrow. Dr. Channick likens the field to six degrees of Kevin Bacon, since almost any specialty connects to pulmonary hypertension, including hepatology, infectious disease, substance use, and amphetamine-associated disease. Transplant colleagues are sometimes needed as well.

Dr. McLaughlin then asks Dr. Channick about remaining gaps. He says progress breeds impatience, because clinicians can now see what is possible and no longer accept fatalism. The approach is aggressive, optimistic, and proactive, although some patients still do not respond well enough. Dr. McLaughlin recalls that early treatment meant anticoagulants and a box of tissues, whereas today more than a dozen FDA-approved therapies exist.

Dr. Vaidya outlines the four pathways. The nitric oxide pathway includes PDE5 inhibitors and the soluble guanylate cyclase stimulator, the endothelin pathway offers three receptor antagonists, and the prostacyclin pathway spans oral, inhaled, subcutaneous, and intravenous agents. The newest is activin signaling inhibition. The first three are vasodilators with additional antiproliferative effects, and all four work in complementary combinations.

"Initial PAH Therapy: Upfront Dual Oral Combination and Guideline Risk Stratification,"

 Dr. Channick and Dr. Kim review how guidelines and landmark trials support upfront dual therapy.

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Intermediate- and high-risk status signals a struggling right ventricle and a prognosis the panel considers unacceptable. They argue for treating risk assessment as a routine vital sign while weighing what patients say they want from therapy.

PAH Risk Assessment: Why Reaching Low Risk Matters for Patients

Welcome back to another HCPLive Peer Exchange series. In "PAH Risk Assessment: Why Reaching Low Risk Matters for Patients," moderator Vallerie McLaughlin, MD is joined by Richard Channick, MD, Anjali Vaidya, MD, FACC, FASE, FACP, and Nick H. Kim, MD to open the series on pulmonary arterial hypertension.

Dr. McLaughlin outlines a program that spans guideline-based risk stratification, combination therapy, route of administration, escalation and switching, and newer therapies, then asks Dr. Kim what the treatment burden looks like for patients who have not reached low-risk status. Dr. Kim notes that many patients are diagnosed late and remain symptomatic even on treatment.

He explains that risk assessment combines clinical and laboratory data to gauge the health of the right ventricle, so an intermediate or high-risk label means the right ventricle is still struggling. In his view that status is not acceptable, and the goal is to bring every patient to low risk. He compares risk assessment to a new vital sign, closest to a hemoglobin A1c in this disease, and cites registry data showing hospitalization and mortality above 20% per year in high-risk patients.

Dr. Vaidya adds that patients rarely ask about their risk category and instead say they want to feel better, spend time with family, attend events, and stay out of the hospital. She argues that quality of life and functional capacity matter as much as formal calculations, although validated questionnaires are hard to complete at every visit.

Dr. Channick cautions that risk calculators work best at the population level, because each patient has different variables and needs an individualized assessment. His central message is that patients must be reassessed by whatever method the clinician prefers, and he calls patients who never get reassessed the bigger problem. As treatment options expand, frequent and regular follow-up becomes even more important.

"PAH Care Teams, Unmet Needs, and the Four Treatment Pathways,"

 turns to the multidisciplinary team and Dr. Vaidya's overview of the four treatment pathways.

 (PH) diagnosis depends on integrating right heart catheterization (RHC) hemodynamics with echocardiography rather than relying on either test alone, according to Anjali Vaidya, MD. Vaidya is professor of medicine and assistant dean of faculty development at the Lewis Katz School of Medicine at Temple University, as well as director of the Advanced Pulmonary Hypertension, Right Heart Failure & CTEPH Program, director of the pulmonary hypertension fellowship, and associate program director of the cardiology fellowship at Temple University Hospital.

 after the session "Navigating Complex Hemodynamics: Right Heart Catheterization, Waveforms, and Echocardiography" at the 

CHEST 2026 Annual Meeting held in Phoenix, Arizona, from October 18-21.

 The session reviewed RHC setup, waveform interpretation, and bedside point-of-care ultrasound alongside hemodynamics, building on her focus on 

Pair Echo With Right Heart Catheterization in PH: Anjali Vaidya, MD

"I think one of the biggest takeaways from everybody's talks really was the importance of integrating all of the data together clinically, and that one test alone is not the end-all be-all. And particularly as we have spent so many years focusing on right heart catheterization as the gold standard in our diagnostics, there was a really nice opportunity to go through in detail the potential pitfalls and limitations," Vaidya said.

On technique, Vaidya pointed to patient and transducer positioning, leveling and zeroing, troubleshooting artifact, and accounting for pleural pressure swings across the respiratory cycle, including when to average values over several cycles instead of reading at end-expiration. She also cited interpreting V waves in valvular disease, readings in intubated patients, and confirming wedge position with wedge oximetry and balloon volume adjustment to avoid over- or under-occlusion.

Echocardiography adds chamber size, shape, and structure on the right side of the heart, Doppler parameters reflecting right ventricular afterload and pulmonary vascular resistance, and 2D and Doppler signs of left heart disease, Vaidya said. Reviewing the echocardiogram before performing and interpreting RHC helps predict the hemodynamic profile and flags when catheter measurements need troubleshooting.

Her group developed the Virtual Echocardiography Screening Tool (VEST), which applies echocardiographic scoring to a routine echocardiogram report to stratify patients as more likely to have pulmonary arterial hypertension (PAH) or pulmonary venous or left heart disease hemodynamics.

 Vaidya noted patients with PAH still face a 2.5- to 3-year delay from symptom onset to diagnosis, a gap integrated assessment aims to narrow.

Relevant disclosures for Vaidya include Bayer, Janssen, Merck, and United Therapeutics.

Navigating complex hemodynamics: right heart catheterization, waveforms, and echocardiography. Session presented at: CHEST 2026 Annual Meeting; October 18-21, 2026; Phoenix, AZ.

New technology developed at the Lewis Katz School of Medicine at Temple University promises faster, earlier diagnosis of deadly form of heart failure. News release. Temple Health. June 4, 2025. Accessed October 19, 2026. https://www.templehealth.org/about/news/new-technology-developed-at-the-lewis-katz-school-of-medicine-at-temple-university-promises-faster-earlier-diagnosis-of-deadly-form-of-heart-failure

Anjali Vaidya, MD, explains why echocardiography should inform right heart catheterization interpretation in pulmonary hypertension at CHEST 2026.

Sotatercept, an activin signaling inhibitor approved for pulmonary arterial hypertension (PAH), continues to build an evidence base spanning exercise capacity, hemodynamics, and hard clinical outcomes. Anjali Vaidya, MD, of Temple University, discussed a 3-pronged framework for understanding the drug's effect on the right ventricle (RV), covering afterload, RV structure, and RV function, in an interview with 

European Society of Cardiology (ESC) Congress 2026

How Sotatercept Reshapes the Right Ventricle in PAH, With Anjali Vaidya, MD

Sotatercept's efficacy is grounded in a pair of pivotal phase 3 trials. The STELLAR trial demonstrated significant improvement in 6-minute walk distance and 8 of 9 secondary end points, supporting US Food and Drug Administration (FDA) approval in 2024, and the more recent ZENITH trial in high-risk patients with PAH found a 76% reduction in the risk of death, lung transplantation, or PAH-related hospitalization, halting enrollment early for efficacy.¹²

Sotatercept's Distinct Effect on RV Afterload in PAH

Vaidya described sotatercept as a fundamentally different mechanism than existing PAH therapies: "It works as an anti-proliferative and really getting to the basis of the pathophysiology of pulmonary arterial hypertension," she said. "We're seeing dramatic improvements and reversals in pulmonary vascular resistance, the load on the right heart... but we are seeing dramatic improvements in all of the clinical markers of pulmonary pressures, right ventricular structure, size, function, biomarkers, and and really so many of the metrics that we have known for many years now that correlate with prognosis and risk assessment."

Asked what changes in pulmonary vascular resistance and other hemodynamic parameters were most informative, Vaidya said the drug's effect is specific to afterload itself, including impedance to flow, vascular resistance, and pulmonary arterial compliance, rather than pressure reduction alone. She noted these parameters are not always measured directly in standard clinical care, despite being central to the hemodynamic abnormalities driving downstream structural and functional changes in the right heart.

Vaidya said the magnitude of this afterload effect distinguishes sotatercept from prior pulmonary vasodilator classes, describing the pattern as fundamentally different and greater in scale than what other PAH therapies have achieved. Despite multiple effective agents across several classes and pathways developed over recent years, she said the activin signaling inhibitor produces a markedly larger reduction in afterload and pulmonary vascular resistance in many patients.

RV Function, Structure, and the Case for Reverse Remodeling

On evidence for RV function improvement specifically, rather than simply reduced workload, Vaidya pointed to a broad set of metrics. "We're seeing improvements in RV work, the magnitude of energy generated by the right ventricle in... every heartbeat of... stroke volume into the pulmonary artery. We're seeing improvements in RV size. We're seeing improvements in RV to LV relationships in size. We're seeing improvements in RV fractional area change. We're seeing improvements in biomarkers of NT-proBNP and BNP. We're seeing dramatic improvements as well in tricuspid regurgitation, another marker of overall right heart performance," she explained.

On RV structure specifically, Vaidya said reverse remodeling encompasses right ventricular size, right ventricle-to-left ventricle relationships, and end-diastolic and end-systolic volumes. She acknowledged some of these changes are likely related to the drop in afterload, but noted the durability of the improvements raises the possibility of an intrinsic effect on the right ventricle beyond load reduction alone, an area she said warrants further study.²

Asked which of the 3 domains, afterload, structure, or function, is the primary driver of clinical benefit, Vaidya described them as inseparable. "The pathogenesis begins in the afterload, in the pulmonary arterial circulation, but the disease manifests in the structure and performance of the right side of the heart," she said. "You look at the right heart to see what's happening in the pulmonary circulation, and the coupling of the two together is really what... manifests in the greatest long-term benefit for our patients."

Editors’ note: Vaidya reports relevant disclosures with Johnson & Johnson, Merck, and United Therapeutics.

Hoeper MM, Badesch DB, Ghofrani HA, et al; STELLAR Trial Investigators. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med. 2023;388(16):1478-1490. doi:10.1056/NEJMoa2213558

Humbert M, McLaughlin VV, Badesch DB, et al. Sotatercept in patients with pulmonary arterial hypertension at high risk for death. N Engl J Med. 2025;392(20):1987-2000.

Anjali Vaidya, MD, breaks down sotatercept's distinct effects on RV afterload, structure, and function in pulmonary arterial hypertension.

Anjali Vaidya, MD, FACC, FASE, FACP

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