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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, MD, MPH, FASE, Chair, Lawrence G. Rudski, MDCM, FASE, Co-Chair, Karima Addetia, MD, FASE, Jonathan Afilalo, MD, MSc, Michele D’Alto, MD, PhD, Benjamin H. Freed, MD, FASE, Lynsy B. Friend, ACS, RCS, FASE, Luna Gargani, MD, PhD, Julia Grapsa, MD, PhD, FASE, Paul M. Hassoun, MD, Lanqi Hua, RDCS, FASE, Jiwon Kim, MD, FASE, Valentina Mercurio, MD, PhD, Rajan Saggar, MD, and Anton Vonk-Noordegraaf, MD, PhD,
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.
Accreditation Statement:
The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)â„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®. Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.
ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.
Release Date: March, 2025
Expiration Date: March 3, 2026 - CME/MOC must be claimed by this date.
Monica Mukherjee, MD, MPH, FASE, Chair, Lawrence G. Rudski, MDCM, FASE, Co-Chair, Karima Addetia, MD, FASE, Jonathan Afilalo, MD, MSc, Michele D’Alto, MD, PhD, Benjamin H. Freed, MD, FASE, Lynsy B. Friend, ACS, RCS, FASE, Luna Gargani, MD, PhD, Julia Grapsa, MD, PhD, FASE, Paul M. Hassoun, MD, Lanqi Hua, RDCS, FASE, Jiwon Kim, MD, FASE, Valentina Mercurio, MD, PhD, Rajan Saggar, MD, and Anton Vonk-Noordegraaf, MD, PhD,
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.
Accreditation Statement:
The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)â„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®. Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.
ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.
Release Date: March, 2025
Expiration Date: March 3, 2026 - CME/MOC must be claimed by this date.
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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, MD, MPH, FASE, Chair, Lawrence G. Rudski, MDCM, FASE, Co-Chair, Karima Addetia, MD, FASE, Jonathan Afilalo, MD, MSc, Michele D’Alto, MD, PhD, Benjamin H. Freed, MD, FASE, Lynsy B. Friend, ACS, RCS, FASE, Luna Gargani, MD, PhD, Julia Grapsa, MD, PhD, FASE, Paul M. Hassoun, MD, Lanqi Hua, RDCS, FASE, Jiwon Kim, MD, FASE, Valentina Mercurio, MD, PhD, Rajan Saggar, MD, and Anton Vonk-Noordegraaf, MD, PhD,
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.
Accreditation Statement:
The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®. Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.
ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.
- Release Date: March, 2025
- Expiration Date: March 3, 2026 - CME/MOC must be claimed by this date.
Course/Activity Information
Learning Objectives:
- Obtain all optimal acoustic windows and echocardiographic views and parameters required for right heart evaluation
- Define normal and abnormal values for right heart size and hemodynamic function
- Provide standard image acquisition and reporting for right sided measures in clinical practice
- Apply echo parameters to distinguish pre-capillary from post-capillary pulmonary hypertension
- Use echocardiography in screening, detection, monitoring of therapeutic response, and to predict outcomes in pulmonary hypertension
Accreditation Statement:
The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Society of Echocardiography designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program, the American Board of Pediatrics (ABP) MOC program, and/or the American Board of Anesthesiology’s (ABA) Maintenance of Certification in Anesthesiology Program® or MOCA 2.0®. It is ASE’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM and ABP MOC points and/or ABA MOCA 2.0®. Physicians will earn MOC and/or MOCA 2.0 points equivalent to the amount of CME credits claimed for the activity.
ARDMS and CCI recognize ASE’s certificates and have agreed to honor the CME credit hours toward their registry requirements for sonographers.
- Release Date: March 3, 2025
- Expiration Date: March 3, 2026 - CME/MOC must be claimed by this date.
Disclosures:
ASE is committed to ensuring that its educational mission, and all accredited continuing educational programs provide a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.
While a monetary or professional affiliation with an ineligible company does not necessarily influence a speaker’s presentation, the Standards for Integrity and Independence in Accredited Continuing Education and policies of the ACCME require that all financial relationships with ineligible companies* be identified and mitigated prior to engaging in an accredited CE activity. In accordance with these policies, ASE actively identified relevant financial relationships between faculty in control of this accredited CE activity and ineligible companies and implemented mitigation strategies to eliminate any potential influence from persons or organizations that may have an incentive to insert commercial bias in this activity. (*Companies that are ineligible to be accredited in the ACCME System (“ineligible companies”) are those whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.)
At the time this article was published, the authors reported no actual or potential conflict of interest relative to the content.
Members of the ASE CME Committee members (not serving as faculty) do not have any financial relationships with ineligible companies. Click here for a list of these members.
None of the ASE staff who were involved in the planning and implementation of this educational activity have relevant financial relationship(s) to disclose with ineligible companies. Click here for a list of ASE staff members.
No commercial support was provided for this activity.
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