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Purpose: Pulmonary hypertension is a frequent finding in patients with cardiopulmonary disorders. It is important to recognize pulmonary hypertension due to increased pulmonary vascular resistance (PVR). In a recent study we describe a novel echocardiography method to identify patients with increased PVR (>3 WU) based on detection of pressure reflection (PR) in the pulmonary artery (PA). The patient population studied was biased towards high PVR and therefore, in the present study we evaluate the method in a more representative population undergoing right heart catheterization.Methods: Echocardiography and catheterization were performed within one week in 108 patients. Three PR variables were selected: the interval from valve opening to peak velocity in the PA (AcT, ms), the interval between PA peak velocity and peak tricuspid velocity (tPV-PP, ms), and the right ventricular pressure increase after peak velocity in the PA (augmented pressure, AP, mm Hg). Cut-of values indicating increased PVR for Act, tPV-PP, AP were <103 ms, > 89 ms, >8 mmHg.Results: The mean±SD age was 52±14 years, 44% were female. Forty-six percent had left heart disease, 21% were heart transplant patients and 18% had pulmonary arterial hypertension. The proportions with increased PAMP (>25 mmHg) increased pulmonary capillary wedge pressure (PCWP>12 mHg), increased PVR (>3 WU) or both increased PVR and PCWP were 54%, 40%, 36% and 15%. There was no significant linear relation (correlation coefficient, R) between PCWP and AcT (R=0.18), tPV-PP (R=0.11) and AP (R=0.10). The positive predictive value was 94% with equal to or > 2 PR variables and the negative predictive value was 92% with no PR variables present (Table).Conclusions: Assessment of PR in the pulmonary circulation identifies patients with normal as well as increased PVR and the finding suggest that echocardiography can be used as a gatekeeper for right heart catheterization.