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

摘要

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. 近十余年来，肺高血压在定义、流行病学、高危人群、病因、病理生理学，以及临床分类、风险评估、诊断与治疗策略等方面均取得显著进展。超声心动图是肺高血压的一线筛查方法和最常用的无创诊断手段以及最重要的系统性评估检查策略之一，对肺高血压的筛查、诊断和治疗具有非常重要的意义。但是，迄今为止我国鲜见统一、规范和标准化的肺高血压超声心动图筛查及诊断流程，这导致不同中心、不同操作者超声心动图检测指标和报告结果存在较大差异。不同临床专家对超声心动图的检测指标及结果解读各异，明显地制约了超声心动图在肺高血压诊治指导中的广泛应用。为了进一步提升我国超声心动图在成人肺高血压规范化筛查、诊断、风险评估、治疗目标制定和治疗效果判断中的准确性及一致性，同时为超声医师及临床医师提供一个科学的临床应用指南，中国医师协会心血管内科分会肺血管学组、中国超声心动图学会和中国康复医学会心血管疾病预防与康复专委会组织心血管病学、肺血管病学、呼吸病学和超声影像学等各领域的相关专家，根据国内外最新研究成果及国内外的循证医学证据，结合国际肺高血压心动超声检查最新指南或共识，制订了本指南。本指南根据不同级别医院和肺高血压中心肺血管专业医师及超声心动图技术人员条件分层描述，整合出适合不同级别医院或中心的超声心动图操作流程及采集参数，再根据临床诊治阶段及需求，将流程逐一展开到筛查、诊断、评估和随访等全疾病周期，从而为不同背景及级别医院和医师提供统一的超声心动图应用路径及指标采集，为进一步规范我国超声心动图评估成人肺高血压提供参考。.