Clinical application of echocardiography in the diagnosis and treatment of adult pulmonary hypertension: a Chinese guideline (2026)

Over the past decade, significant advances have been made in the definition, epidemiology, identification of high-risk populations, aetiology, pathophysiology, clinical classification, risk stratification, and diagnostic and therapeutic strategies for pulmonary hypertension. Echocardiography remains the primary first-line screening tool and the most widely used initial diagnostic modality, and it is essential for longitudinal follow-up and assessment of treatment response. However, to date, a unified, standardized, and protocol-based echocardiographic pathway for screening and diagnosing pulmonary hypertension remains lacking in China, resulting in marked inter-center and inter-operator variability in echocardiographic parameters and reporting. Differences among clinical experts in the selection and interpretation of echocardiographic measurements have further limited the broad application of echocardiography in guiding the diagnosis and management of pulmonary hypertension. To improve the accuracy and consistency of standardized echocardiographic screening, diagnosis, risk assessment, treatment target setting, and therapeutic response evaluation in adult pulmonary hypertension in China, experts in cardiology, pulmonary vascular medicine, respiratory medicine, and echocardiographic imaging were convened by the Pulmonary Vascular Group of Chinese Medical Doctor Association of Cardiology, Chinese Society of Echocardiography, and Specialized Committee of Cardiovascular Disease Prevention and Rehabilitation of the Chinese Association of Rehabilitation Medicine to develop this guideline based on the latest domestic and international evidence, as well as recent international guidelines and consensus statements.This guideline provides stratified recommendations according to hospital capabilities and the expertise of pulmonary vascular physicians and echocardiographic technicians, and integrates echocardiographic workflows and acquisition parameters applicable to different levels of medical institutions. The workflow spans the entire disease course, including screening, diagnosis, assessment, and follow-up. This guideline aims to establish a unified pathway for echocardiographic application and parameter acquisition across institutions and physicians of varying backgrounds and levels, and to serve as a reference for further standardizing echocardiographic evaluation of adult pulmonary hypertension in China.