Hi Vladislavs,

The diagnosis of PHT mandatorily requires right heart catheterisation. See 2015 PHT Guidelines. EHJ doi:10.1093/eurheartj/ehv317. 

This is important for allowing risk stratification of PHT patients and for reimbursement for specific treatment. 

if you have only non-invasive echo, you will have trouble with the reviewers linked to the specific care of PHT patients. You will nevertheless be able to publish in interesting imaging journals (EHJ-CVI, JACC-imaging, JASE) provided you do not claim the diagnosis of PHT, but rather the observation of elevated pulmonary pressures or increased TR velocity.

The diagnosis of elevated TR velocity is increasingly used as it has a better prognostic yield than calculated pulmonary pressures at least in HFpEF patients (see Amil Shah Circ Heart Fail. 2014;7:740-751).

In addition to pulmonary pressures you should mention data on RV function such as TAPSE of the tricuspid lateral annulus. See Mohammed Circulation . 2014;130:2310-2320.

It is rather about semantics and tradition. If you have good and prognostically valid data with echo parameters, they will be considered by the reviewers, even if you do not have cath data. 

Best regards,

Thierry

Editorial board reviewer for EHJ, EHJ-CVI, JACC, JACC-im and JASE. 

Thank you very much! It is truly a very helpful advice.

Best regards, Vlad

You could also consider using RV longitudinal strain, which correlates with  invasive hemodynamic parameters like mean PAP and PVR measured duringy right heart catheterization in PAH patients. It was also show that it may have a prognostic value in PAH.

See: Park JH, Kusunose K, Kwon DH, et al. Relationship between right ventricular longitudinal strain, invasive hemodynamics, and functional assessment in pulmonary arterial hypertension. Korean Circ J. 2015;45:398–407.

Echocardiography as an alternative to right-heart catheterization to assess and estimate pulmonary hypertension

Although right heart catheterization is a gold-standard to confirm pulmonary hypertension used for research and when cardiac catherization is part of the surgical management, it is not practical to do it for all cases.

Therefore in clinical practice, Echocardiography is often used in the evaluation of secondary causes of pulmonary hypertension (1). If evaluated by following the standard protocol and guidelines by an experienced and expert cardiologist, a noninvasive, relatively inexpensive study can be done for publication in a good-impact journal (3).

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