Transthoracic echocardiography serves as the initial diagnostic modality for suspected pulmonary hypertension, with right heart catheterization confirming mean pulmonary artery pressure exceeding 20 mmHg per 2022 guidelines. 
Multiple echocardiographic algorithms estimate mPAP using tricuspid regurgitation velocity, pulmonary regurgitation, or acceleration time, but validation remains limited to small cohorts predating the revised threshold. In the study published in the American Journal of Echocardiography, the investigators prospectively enrolled consecutive patients undergoing clinically indicated right heart catheterization and echocardiography within seven days at a pulmonary hypertension referral center over 10 years. 
Five established formulas derived from tricuspid regurgitation, minimal end-diastolic pulmonary regurgitation pressure (mPAPDPmin), and pulmonary flow acceleration time underwent head-to-head comparison. 
Severe PH Burden in Referral Cohort
Among 571 patients averaging 68 years with equal gender distribution, 450 (79%) met PH criteria, reflecting real-world referral severity. All formulas demonstrated significant correlation with catheter-derived mPAP (P<0.001 for each), confirming echocardiographic utility across parameters.
PR-Based Formula Dominates Accuracy
The mPAPDPmin formula, leveraging minimal end-diastolic pulmonary regurgitation pressure, achieved superior correlation (R=0.92) versus tricuspid regurgitation velocity-based estimation (AUC 0.96 [95% CI 0.95-0.98] versus 0.91 [0.89-0.93], P<0.001). Alternative acceleration time and other regurgitation-derived approaches trailed significantly. Bland-Altman plots confirmed minimal bias (+1.21 mmHg) for mPAPDPmin with narrow limits of agreement (-7.14 to +9.56 mmHg).
Threshold Performance Guides Screening
At the 20 mmHg diagnostic cutoff, mPAPDPmin delivered 99% sensitivity and 82% specificity, optimizing PH case identification while minimizing false positives in screening scenarios.
Refine Echo Protocols for PH Evaluation
Pulmonary hypertension specialists gain a validated, reproducible formula enhancing noninvasive accuracy before invasive confirmation. Prioritize pulmonary regurgitation interrogation when feasible, reserving tricuspid regurgitation for inadequate windows. Integration into reporting software standardizes estimation across echocardiography laboratories.