Noninvasive Estimation of Right Atrial, Right Ventricular, and Pulmonary Systolic Pressure: "A Good Story Never Ends"

The precise evaluation of pulmonary artery, right atrial, and ventricular pressures is essential for the diagnosis, ongoing management, and therapeutic decision-making in a wide range of cardiovascular conditions, including pulmonary hypertension. Since the early 1980s, the accuracy and consistency of echocardiography in estimating pulmonary artery pressure have been a subject of debate, with multiple formulas developed over time to improve reliability. Despite initial concerns, echocardiography has now been widely accepted as a noninvasive, safe, and readily available alternative to the more invasive right heart catheterization, which remains the gold standard. The growing recognition of echocardiography's role in clinical practice has led to significant advancements in its methodology. This review explores the contribution of echo-Doppler techniques to the assessment of right heart hemodynamics, highlighting their importance in daily practice. It also examines the historical milestones that have facilitated the standardization of various formulas and paved the way for the development of current guidelines. By tracing these developments, the review underscores the relevance of echocardiography in modern cardiology and the importance of continuing to refine its application to ensure accurate and reliable assessments.