Detection of Pulmonary Hypertension in Chronic Lung Diseases: A literature review

Abstract

Pulmonary hypertension (PH) often accompanies ILD and COPD and impacts functional capacity and prognosis, making early screening clinically important. Non-invasive evidence suggests a complementary multimodal approach. DLCO is consistently correlated with the presence and risk of PH, especially when the decrease is not proportional to FVC or FEV1 or when evaluated as an FVC/DLCO or FEV1/DLCO ratio. In HRCT, enlargement of the main pulmonary artery and the ratio of the pulmonary artery to the ascendant aorta add diagnostic value, with interpretations that must consider changes in the parenchyma. Biological markers (e.g., natriuretic peptides) improve rule-out ability, while echocardiography, degree of desaturation, and heart rate recovery on a six-minute walk test strengthen clinical probability. Although right cardiac catheterization remains the gold standard for diagnosis, the integration of DLCO, HRCT metrics, and echocardiography provides a practical pathway for screening, risk stratification, as well as the determination of hemodynamic confirmation referral needs and subsequent management.