[Diagnosis of pulmonary artery hypertensions]

The clinical signs of pulmonary arterial hypertension (PAH) lack specificity and do not permit an early diagnosis. Right heart catheterization is still the reference method to confirm the diagnosis of PAH and assess its severity. Numerous non-invasive methods have been used to evaluate PAH. The value of conventional non-invasive methods is limited by a high failure rate (standard echocardiography in patients with chronic respiratory disease), a mediocre sensitivity, notably in detecting moderate PAH (electrocardiography, radiography of the chest, myocardial thalium scintigraphy) or a poor specificity (isotopic angiography). Nowadays, Doppler-echocardiography is the most interesting method since it has a significant success rate and high sensitivity and specificity in detecting PAH. However, this method fails to predict very accuratly the pulmonary arterial pressure in individual patients. The systematic combination of several Doppler ultrasound methods should improve the efficacy of Doppler-echocardiography in evaluating the severity of PAH.