From the Guidelines
Pulmonary hypertension (PH) can be diagnosed using a combination of clinical evaluation, pulmonary function tests, and imaging examinations. The diagnostic methods for PH include:
- Clinical evaluation: a careful history to evaluate for risk factors for PH, including family history, history of drugs and toxins associated with PH, collagen vascular disease, human immunodeficiency virus, portal hypertension, congenital or left heart disease, and venous thromboembolic disease 1
- Pulmonary function tests: to evaluate for lung disease 1
- Imaging examinations:
- Chest radiography (CXR) 1
- Ultrasound (US) 1
- Echocardiography 1
- Ventilation/perfusion (V/Q) scans 1
- CT 1
- MRI 1
- Right heart catheterization (RHC) 1
- Pulmonary angiography 1
- Fluorine-18-2-fluoro-2-deoxy-D-glucose PET/CT (FDG-PET/CT) 1 The choice of imaging examination depends on the suspected underlying cause of PH and the patient's clinical presentation 1. Right heart catheterization (RHC) is considered the gold standard for diagnosing PH, as it allows for direct measurement of mean pulmonary arterial pressure (mPAP) 1.
From the Research
Diagnostic Methods for Pulmonary Hypertension (PH)
The diagnostic methods for PH involve a combination of invasive and non-invasive tests to detect elevated pulmonary arterial pressures and identify the underlying etiology. The following are some of the diagnostic methods used:
- Clinical history and physical examination to identify symptoms such as dyspnea, fatigue, and syncope 2, 3, 4
- Chest roentgenogram, electrocardiogram, and pulmonary function tests to evaluate the lungs and heart 2, 3, 5, 6
- Transthoracic echocardiogram to estimate the probability of PH and detect elevated pulmonary pressures 2, 3, 5, 6, 4
- Right heart catheterization to accurately diagnose and classify PH 2, 3, 5, 6
- Ventilation-perfusion scan to exclude chronic thromboembolic PH (CTEPH) 5, 6, 4
- Cardiopulmonary stress test to evaluate the functional capacity of the patient 4
- Blood tests, such as (NT-pro-)BNP concentration, to support the diagnosis of PH 4
- Genetic testing, although not currently recommended for routine evaluation 6
- Advanced imaging, such as chest computed tomography, to evaluate the lungs and detect any underlying conditions 6
Referral to Specialist Centers
Patients with suspected or confirmed PH should be referred to a specialist center for further diagnostic assessment, classification, and treatment 3, 5, 4. This is particularly important for patients with pulmonary arterial hypertension (PAH) or CTEPH, as specific treatments are available for these conditions 5, 4.