Shifting Focus to Pulmonary Hypertension in Right Heart Assessment, With Anjali Vaidya, MD

In March 2025, the American Society of Echocardiography introduced a revised version of its Echocardiographic Assessment of the Right Heart Guidelines, which highlighted pulmonary hypertension as a critical indicator in patients with or at risk for cardiopulmonary disease.1

Right heart adaptation to pulmonary hypertension is a major determinant for clinical outcomes, morbidity, and mortality in patients with, or at risk of, cardiopulmonary disease. The hemodynamic definition of pulmonary hypertension was recently updated, setting it at a resting mean pulmonary artery pressure (mPAP) >20 mm Hg, which was done in response to extensive evidence of adverse outcomes and mortality in patients with mPAP between 21 and 24 mm Hg.1

The updated guidelines were presented and broken down at the Pulmonary Hypertension Professional Network Symposium by Anjali Vaidya, MD, director of the advanced pulmonary hypertension, right heart failure & CTEPH program and the pulmonary hypertension fellowship at Temple University.

The editorial team at HCPLive met with Vaidya to discuss her presentation and how clinicians should interpret and utilize these new guidelines to provide better and more efficacious treatment for their patients.

“There is an emphasis on using the echocardiogram, not just for initial diagnosis, but for long-term follow-up of patients to really get a finer, more accurate, precise assessment of a patient’s overall risk with pulmonary hypertension,” Vaidya told HCPLive. “And the shift has really happened in the field away from simply relying on how a patient feels and how far they can walk, to looking at the right side of the heart in very specific detail to determine if patients have adequately reached their lowest risk status.”

In addition to these changes, the stated goals of the guideline revision are as follows:

• To describe the updated pulmonary hypertension classification and how the right heart adapts to emerging PVD, focusing on structural and functional changes in response to increased afterload
• To define optimal acoustic windows and echocardiographic views and parameters required for right heart evaluation
• To provide reference values for normality and grade abnormality
• To present recommendations for assessing tricuspid and pulmonic valve disease and special considerations in pulmonary hypertension
• To propose standard image acquisition and reporting for right-sided measures in clinical practice
• To establish the role of echocardiography in screening, detection, and monitoring of therapeutic response and prognostication of pulmonary hypertension.1

Additionally, the authors included updated equations and methods by which clinicians can calculate and measure other critical factors, including pulmonary vascular resistance, pulmonary artery end-diastolic pressure, and right atrial pressure.1

“These guidelines and the increased awareness of applying these clinical principles using echocardiography should lead to patients getting more high-level expert care,” Vaidya said. “The goal is not to just help them feel better when they’re worse, but to maintain their low-risk status and wellness for an even longer period of time.”

References

1. Mukherjee M, Rudski LG, Addetia K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(3):141-186. doi:10.1016/j.echo.2025.01.006