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| Modality | Advantages | Disadvantages |
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| ECG | Noninvasive, cheap, and readily available.
High specificity for RVH.
ECG may reveal other findings such LAE, LVH, or old MI that suggests an alternative cause of PH | Absence of RVH does not rule out PH. |
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| CXR | Non-invasive, cheap, and readily available.
An ↑ in the diameter of the right descending pulmonary artery to >16 mm on the PA projection, combined with an ↑ in the diameter of the left descending pulmonary artery of >18 mm on the left lateral projection, has a high sensitivity of 98% for PH | Normal-sized pulmonary artery does not rule out PH. |
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| BNP | Requires only a blood draw, is cheap and readily available. | ↑ BNP also correlated with lower PaO2 suggesting that BNP can also be released in response to hypoxia. More studies are needed. |
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| eNO | Non-invasive. | Expensive, not widely available and has been tested in only one study. |
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| ECHO | High NPV of sPAP or RV abnormalities (93% and 96%, resp.) makes it an excellent screening test.
Moreover, it provides additional data for example, LVEF, LV filling pressures, valvular function. | Hyperinflation may preclude optimal visualization of the heart.
Although the NPV is high enough to exclude PH, the presence of a high sPAP or RV abnormalities requires confirmation by RHC. |
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| Chest CT | Non-invasive, widely available.
High PPV of 95%-96% for PH.
LAE could suggest left heart dysfunction. | Expensive.
Radiation exposure.
Normal sized pulmonary artery does not rule out PH. |
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| Cardiac MRI | Non-invasive, does not involve ionizing radiation, and is not affected by hyperinflation. | Expensive, not widely available and in some cases claustrophobia can be a problem. |
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| RHC | “Gold standard”
Confirms diagnosis.
Determines severity.
Distinguishes occult LV dysfunction from hyperinflation when PAWP is ↑.
Measures CO and allows calculation of PVR.
Determines responsiveness to O2. | Invasive.
Interpretation of pressures may be difficult when there are large respiratory swings. |
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