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Noninvasive Imaging in the Evaluation 
of Pulmonary Hypertension

Asghar A Fakhri, MD1, Vikas K Rathi, MD, FACC2, Rachel Hughes-Doichev, MD, FASE1, and Raymond L Benza, MD1

Evaluation of pulmonary artery (PA) hemodynamics, right ventricular (RV) structure, and RV function is crucial in the management of pulmonary hypertension (PH), whether due to left-sided heart failure (LHF), chronic thromboembolic disease, pulmonary parenchymal disease, pulmonary arterial hypertension (PAH), congenital heart disease (CHD), or pathology extrinsic to the PAs [1,2]. Noninvasive cardiac imaging modalities that are currently used to evaluate PH include echocardiography, radionuclide imaging, computed tomography (CT), and cardiovascular magnetic resonance imaging (CMR). Here, we will discuss the utility and merits of each modality, outline comparisons with invasive hemodynamic measurements and clinical outcomes, and summarize the limitations of each modality.

  • Table 1
outlines the utility of each modality. It should be noted that although many of these imaging parameters, especially for echocardiography and CMR, have been evaluated for diagnostic purposes, their role in monitoring response to therapy is less well studied using prospective analyses and requires further validation.

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