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Practice Guideline
. 2025 Mar;38(3):141-186.
doi: 10.1016/j.echo.2025.01.006.

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography

Monica Mukherjee  1 , Lawrence G Rudski  2 , Karima Addetia  3 , Jonathan Afilalo  2 , Michele D'Alto  4 , Benjamin H Freed  5 , Lynsy B Friend  6 , Luna Gargani  7 , Julia Grapsa  8 , Paul M Hassoun  9 , Lanqi Hua  10 , Jiwon Kim  11 , Valentina Mercurio  12 , Rajan Saggar  13 , Anton Vonk-Noordegraaf  14
Affiliations
Practice Guideline

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography

Monica Mukherjee et al. J Am Soc Echocardiogr. 2025 Mar.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Soc Echocardiogr. 2025 Jul;38(7):641. doi: 10.1016/j.echo.2025.05.001. J Am Soc Echocardiogr. 2025. PMID: 40617627 No abstract available.

Abstract

Right heart adaptation to pulmonary hypertension (PH) is a critical determinant of clinical outcomes, morbidity, and mortality in patients with or at risk for cardiopulmonary disease. The World Symposium on Pulmonary Hypertension recently redefined PH as a mean pulmonary arterial pressure >20 mm Hg, based on a wealth of epidemiologic evidence underscoring the significant impact of even mildly elevated mean pulmonary artery pressures on major adverse clinical events. The lowered diagnostic threshold for PH has renewed interest in echocardiography and its critical role in early detection and screening, refined hemodynamic evaluation, and longitudinal monitoring. However, the systematic assessment of the right heart remains inconsistent, largely due to the predominant focus on left heart evaluation, limited familiarity with right heart ultrasound techniques, and a paucity of reference data defining normal right heart size and function. A systematic, comprehensive ultrasound-based assessment of the right heart offers valuable diagnostic insights for in screening at-risk populations, PH classification, risk stratification, monitoring therapeutic response, and informing prognostication, thereby improving clinical outcomes.

Keywords: Echocardiography; Prognosis; Pulmonary hypertension; Right atrium; Right heart; Right ventricle.

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Conflict of interest statement

Conflicts of Interest The following authors reported no actual or potential conflicts of interest in relation to this document: Benjamin H. Freed, MD, Lanqi Hua, RDCS, Jonathan Afilalo, MD, Karima Addetia, MD, Julia Grapsa, MD, PhD, Lynsy B. Friend, RCS, and Rajan Saggar, MD. The following authors reported relationships with one or more commercial interests: Monica Mukherjee, MD, MPH, is supported by the National Scleroderma Foundation, National Heart, Lung, and Blood Institute grant R01HL162851, and US Department of Defense grant PR231648 and serves on the data and safety monitoring board for Advarra, Inc. Jiwon Kim, MD, is supported by National Heart, Lung, and Blood Institute grants R01HL159055 and K23HL140092. Paul M. Hassoun, MD, is supported by National Heart, Lung, and Blood Institute grant R01HL114910 and serves on a scientific committee for Merck Sharpe & Dohme. Anton Vonk-Noordegraaf, MD, PhD, serves on the Netherlands CardioVascular Research Initiative (CVON-2012-08 PHAEDRA, CVON-2017-10 DOLPHIN-GENESIS) and the Netherlands Organization for Scientific Research (NWO-VICI: 918.16.610); has received speaker honoraria from Johnson & Johnson, Merck Sharpe & Dohme, Actelion, Bayer, and Ferrers; and has served as a member of the scientific advisory boards of Morphogen-X, Ferrer, Gosammer Bio Services, Altavant, Merck Sharpe & Dohme, and Johnson & Johnson. Luna Gargani, MD, PhD, has received honoraria from GE Healthcare, Philips Healthcare, Caption Health, and EchoNous. Lawrence Rudski, MDCM, has minor holdings in GE Healthcare (<$10,000). Michele D’Alto, MD, PhD, has served as a member of the scientific advisory board or received honoraria or travel expenses from Johnson & Johnson, MSD, AOP, Ferrer, Gossamer, and Dompè. Valentina Mercurio, MD, PhD, serves as a scientific consultant for Merck Sharpe & Dohme.

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