The Mechanics Behind PAH Diagnosis and Management, With Anjali Vaidya, MD

In 2022, the European Society of Cardiology (ESC) released a set of comprehensive clinical guidelines for the detection and management of pulmonary arterial hypertension (PAH), emphasizing the importance of a multidisciplinary approach.1

At the American College of Cardiology (ACC) Scientific Sessions 2026 in New Orleans, Louisiana, Anjali Vaidya, MD, assistant dean at the Lewis Katz School of Medicine and director of advanced pulmonary hypertension, right heart failure, and the CETPH Program at Temple Health, spoke on the implementation of these guidelines. The editorial team at HCPLive met with Vaidya at the conference to learn more.

“The guidelines have evolved a lot over the years, which has been a wonderful thing to see,” Vaidya told HCPLive. “But the inclusion of imaging modalities, and particularly electrocardiography, has really expanded in those guidelines. More and more advancement is being made, and more parameters are being included – I think we’ll continue to see that grow even further with the next iteration of guidelines.”

The ESC guidelines focus heavily on reanalyzing the hemodynamic definition of PAH. The authors officially updated the condition’s classification, repositioning vasoreactive patients with idiopathic PAH and developing a new algorithm for earlier detection of PAH in the community. The document also posits new, expedited screening and referral strategies.1

Vaidya notes, however, that the most impactful aspect of the current guidelines is the emphasis on imaging in patients with PAH. Echocardiographic and cardiac magnetic resonance imaging (cMRI) parameters are proposed within the document, aiming to help clinicians monitor right ventricle function during the disease’s progression.

“The highest yield of imaging modality for pulmonary hypertension diagnosis is going to be echocardiography, or ultrasound of the heart, from an imaging perspective,” Vaidya said. “This is embedded in all of the pulmonary hypertension guidelines for diagnosis, and there are a lot of different parameters that can be interpreted to give us clues into the diagnosis of pulmonary hypertension.”

Vaidya also provides advice for clinicians entering the sphere of PAH management. She guides newcomers to make themselves familiar with the actual data of their patients rather than allowing technology to manage the numbers. Vaidya emphasizes the importance of being able to interpret data oneself to avoid mechanical errors or complications and to become more familiar with the condition and its effects.

“The most important thing is to practice and become comfortable with looking at the imaging directly rather than relying on reports,” Vaidya said. “There’s so much information available when you look at the pictures of cardiovascular structures, whether that’s on chest X-ray or CT scan or echocardiography, that is sometimes nuanced and subtle, so the biggest first step is to take a dive into it and open those images directly to become more and more comfortable with interpreting and not missing clues.”

Editors’ Note: Vaidya reports disclosures with Bayer, Janssen, Merck, and United Therapeutics.

References

1. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2022;43(38):3618-3731. doi:10.1093/eurheartj/ehac237