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

Accurate pulmonary hypertension (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.

Vaidya spoke with HCPLive after the session "Navigating Complex Hemodynamics: Right Heart Catheterization, Waveforms, and Echocardiography" at the CHEST 2026 Annual Meeting held in Phoenix, Arizona, from October 18-21.1 The session reviewed RHC setup, waveform interpretation, and bedside point-of-care ultrasound alongside hemodynamics, building on her focus on PH in right heart assessment.

"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.2 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.

References

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

2. 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