For patients with pulmonary hypertension, the distance between first symptom and confirmed diagnosis has long stretched across years — years in which a quiet disease advances unchecked. At the CHEST 2026 Annual Meeting in Phoenix, Temple University cardiologist Anjali Vaidya made the case that this delay is not inevitable, but is partly a consequence of how medicine has leaned too heavily on a single diagnostic tool. By integrating right heart catheterization with echocardiography — and deploying early screening instruments like VEST — clinicians may finally be able to meet the disease before
Combining Echocardiography With Right Heart Catheterization Improves PH Diagnosis
Patients with pulmonary arterial hypertension experience a 2.5-3 year delay from symptom onset to diagnosis, delaying critical treatment.
One test alone is not the end-all be-all
Mark
So the argument is that right heart catheterization alone isn't enough to diagnose pulmonary hypertension?
Mimi
Exactly. Catheterization gives you the pressures and flows—the hemodynamics. But it doesn't show you the structure of the heart, how the chambers are shaped, whether the right ventricle is dilated or straining. Echocardiography shows all of that.
Luke
But hasn't catheterization been the gold standard for decades? What changed?
Mimi
It still is the gold standard for hemodynamic measurement. What changed is the recognition that hemodynamics alone can be misleading without structural context. A pressure reading means something different depending on chamber size and function.
Mark
Can you give a concrete example?
Mimi
Sure. If you see a certain pressure pattern in the catheter but the echocardiogram shows the right ventricle is normal-sized and contracting well, that tells you something different than if it's hugely dilated and barely moving. Same numbers, different disease.
Luke
So this is really about interpretation, not about the tests themselves being wrong?
Mimi
Right. The tests aren't wrong. But interpreting one without the other leaves you vulnerable to misreading what you're seeing. Technical factors matter too—how you position the patient, how you zero the equipment, how you account for breathing.
Mark
And that's where the delays come in? Patients waiting years for diagnosis?
Mimi
Yes. If you're only looking at one test, you might miss the diagnosis or misclassify what kind of pulmonary hypertension it is. The VEST tool is trying to catch patients earlier by using routine echo reports to flag who needs catheterization.
Luke
How well does VEST work? Is there data on whether it actually narrows that 2.5-to-3-year gap?
Mimi
That's the forward-looking question. The tool was developed at Temple, but the real test is whether it changes outcomes in practice—whether patients actually get diagnosed faster and start treatment sooner.
Le Pouls
- Pulmonary arterial hypertension patients wait an average of 2.5 to 3 years for a diagnosis, a window during which the right heart silently deteriorates and treatment options narrow.
- Right heart catheterization, long treated as the gold standard, carries blind spots — its pressure readings can be distorted by positioning errors, respiratory swings, and waveform misreads that go undetected without echocardiographic context.
- Echocardiography reveals what catheterization cannot: chamber size, septal bowing, right ventricular strain, and Doppler estimates of vascular resistance — together forming a diagnostic picture neither test can produce alone.
- Temple University's VEST tool applies a scoring algorithm to routine echo reports to flag high-risk patients earlier, aiming to intercept the disease before it reaches the catheterization lab.
- The integration of both modalities — and the technical discipline required to execute them accurately — represents the field's best current path toward closing the diagnostic gap that costs patients years of treatable time.
For patients with pulmonary hypertension, the distance between first symptom and confirmed diagnosis has long stretched across years — years in which a quiet disease advances unchecked. At the CHEST 2026 Annual Meeting in Phoenix, Temple University cardiologist Anjali Vaidya made the case that this delay is not inevitable, but is partly a consequence of how medicine has leaned too heavily on a single diagnostic tool. By integrating right heart catheterization with echocardiography — and deploying early screening instruments like VEST — clinicians may finally be able to meet the disease before it has done its worst work.
Pulmonary hypertension announces itself softly — breathlessness, fatigue, chest discomfort — symptoms that could belong to almost any condition. By the time a diagnosis arrives, nearly three years have typically passed. That gap is where the disease does its damage, and it is where Anjali Vaidya, a cardiologist and program director at Temple University Hospital, has focused her work.
Presenting at the CHEST 2026 Annual Meeting in Phoenix, Vaidya argued that the field's long reliance on right heart catheterization as the singular diagnostic standard has created a structural blind spot. Catheterization measures pressure and flow in the right heart and pulmonary arteries with precision — but precision is not the same as completeness. Echocardiography provides what catheterization cannot: a direct view of chamber geometry, right ventricular function, septal position, and Doppler estimates of pulmonary vascular resistance. Reviewing an echocardiogram before catheterization allows clinicians to anticipate the hemodynamic profile they should find — and to recognize when the numbers don't fit.
The technical execution of both tests carries weight. Patient positioning, transducer zeroing, artifact elimination, and respiratory cycle averaging are not procedural formalities — they determine whether measurements are trustworthy. Waveform patterns like V waves require echocardiographic knowledge of valve function to interpret correctly. In intubated patients, balloon placement must be confirmed through wedge oximetry to avoid false readings.
To address the diagnostic delay upstream, Vaidya's group developed VEST — the Virtual Echocardiography Screening Tool — which scores routine echo reports to stratify patients by likelihood of pulmonary arterial hypertension versus left heart disease. The goal is to identify high-risk patients before they reach the catheterization lab, narrowing the years-long interval during which the disease progresses and the right heart weakens. Integrating both diagnostic tools, and deploying screening earlier in the clinical pathway, is the attempt to reach patients while the window for effective treatment remains open.
Pulmonary hypertension kills quietly. Patients notice breathlessness, fatigue, chest discomfort—symptoms that could mean almost anything. By the time they reach a diagnosis, two and a half to three years have often passed. That diagnostic gap is where the real damage happens, and it's where Anjali Vaidya, a cardiologist at Temple University, is trying to intervene.
Vaidya presented her thinking at the CHEST 2026 Annual Meeting in Phoenix in October, during a session on right heart catheterization and echocardiography. Her central argument is straightforward but has taken years to establish in practice: no single test tells the whole story of pulmonary hypertension. Right heart catheterization—the procedure that measures pressure and flow in the heart's right chambers and pulmonary arteries—has long been treated as the diagnostic gold standard. But it is incomplete. Echocardiography, the ultrasound imaging of the heart, provides what catheterization cannot: a direct view of chamber size, shape, and structure, along with Doppler measurements that reveal how hard the right ventricle is working against the resistance in the lungs. Together, the two tests create a picture neither can produce alone.
Vaidya directs the Advanced Pulmonary Hypertension, Right Heart Failure & CTEPH Program at Temple University Hospital and serves as professor of medicine and assistant dean of faculty development at the Lewis Katz School of Medicine. She emphasized that the session's central lesson was the necessity of integration. "One test alone is not the end-all be-all," she said. For years, the field has focused intensely on right heart catheterization as the definitive measure. That focus was warranted—the procedure provides irreplaceable hemodynamic data. But it also created a blind spot. Catheterization readings can be misinterpreted or confounded by technical factors that echocardiography can clarify.
The technical details matter enormously. How the patient is positioned, how the transducer is leveled and zeroed, how artifacts are identified and eliminated—these are not minor adjustments. They determine whether the numbers mean what clinicians think they mean. Vaidya pointed to the importance of accounting for pressure swings across the respiratory cycle, sometimes requiring values to be averaged over several breaths rather than read at a single moment. Interpreting certain waveform patterns, like V waves in patients with valve disease, requires knowing what the echocardiogram shows about valve function and chamber geometry. In intubated patients, the mechanics change entirely. Confirming that the catheter's balloon is in the correct position—using wedge oximetry and careful balloon adjustment—prevents the false readings that come from over- or under-occlusion.
Echocardiography provides the context that makes these technical decisions intelligible. It shows whether the right ventricle is dilated or normal-sized, whether it's contracting well or struggling, whether the septum between the right and left ventricles is bowed (a sign of right heart strain), and whether there are signs of left heart disease that might explain the patient's symptoms. Doppler measurements estimate pulmonary vascular resistance and right ventricular afterload. Reviewing the echocardiogram before performing catheterization allows clinicians to predict what hemodynamic profile they should expect to find, and to recognize when measurements don't fit the picture—a signal that something needs troubleshooting.
Vaidya's group developed a tool called the Virtual Echocardiography Screening Tool, or VEST, which applies a scoring system to routine echocardiogram reports to stratify patients as more likely to have pulmonary arterial hypertension or, alternatively, pulmonary venous or left heart disease. The tool is designed to flag high-risk patients earlier, before they reach the catheterization lab. For patients with pulmonary arterial hypertension, that early identification could narrow the gap between symptom onset and diagnosis—currently running at nearly three years. That delay is not merely inconvenient. It is the interval during which the disease progresses unchecked, the right heart weakens, and the window for effective treatment narrows. Integrating echocardiography and catheterization, and deploying screening tools like VEST, is an attempt to close that window before it closes on the patient.
Citations marquantes
The importance of integrating all of the data together clinically, and that one test alone is not the end-all be-all. There was a really nice opportunity to go through in detail the potential pitfalls and limitations.— Dr. Anjali Vaidya, Temple University
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