Unbowed, unbent, unbroken: predicting pulmonary hypertension using echocardiography

During the first meeting of the World Health Organization (WHO) in 1973, pulmonary hypertension (PH) was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg measured by right heart catheterisation [1]. This criterion was chosen arbitrarily and was founded on the premise that mPAP at rest in a supine position does not exceed 15 mmHg 2]. In 2009, the landmark paper of Kovacs et al . [3] provided scientific evidence for this statement and showed that normal mPAP at rest was 14 mmHg, with an upper limit of normal of 20 mmHg. In addition, accumulating data has indicated that patients with mPAP ≥19 mmHg but below the haemodynamic threshold of 25 mmHg are at increased mortality risk [4–6]. The probability of pulmonary hypertension can accurately be estimated by current echocardiographic criteria We thank Linda Grutterink, senior sonographer at the Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands, for the contribution of the echocardiographic images.