Introduction: Chronic pulmonary heart disease, secondary to pulmonary arterial hypertension (PAH), represents a major diagnostic challenge in everyday cardiology practice. Severe PAH leads to progressive remodeling of the right heart, whose adaptive mechanisms and thresholds of decompensation remain to be clarified in large echocardiographic cohorts.

Objective: To describe the echocardiographic features of pulmonary heart disease in a cohort of patients with severe PAH, to establish correlations between pulmonary pressures and chamber dilation, and to identify critical thresholds associated with right ventricular (RV) failure.

Methodology: A retrospective, observational, single-center study including 73 consecutive patients. Echocardiographic data (diameters, areas, systolic function, valve disease) were correlated with demographic data. Statistical analyses included Student’s t-test, the Chisquare test, and Pearson correlations.

Results: The mean age of the study population was 61.5 ± 17.8 years, with a female predominance (53.4%) and severe PAH (systolic pulmonary artery pressure [sPAP] = 75.2 ± 14.4 mmHg), marked dilation of the RV (43.4 ± 8.8 mm) and of the right atrium (RA) (27.6 ± 8.9 cm²). An anatomo-functional dissociation was observed: 90.4% had preserved RV systolic function, despite RA dilation in 75.3% and grade III tricuspid regurgitation (TR) in 80.8%. Correlations revealed a “cascade” eff ect (sPAP → RV → RA). Factors associated with right ventricular dysfunction were identified for an RV diameter > 50 mm combined with sPAP > 85 mmHg (p<0.01). Pericardial effusion was strongly correlated with left ventricular dilation (p<0.01).

Conclusion: Pulmonary heart disease is found mainly in older patients with a female predominance; the factors associated with right ventricular failure are an RV end-diastolic diameter > 50 mm and sPAP > 85 mmHg. Severe TR is a marker of RA dilation, and the presence of pericardial effusion signals global heart failure.