Background: Although right ventricular (RV) function is an important determinant of morbidity and mortality in patients with pulmonary hypertension (PH), there have been no validated non-invasive quantification methods to date . Advancements in contrast echocardiography (CE) permit transthoracic imaging of RV vortex flow. The purpose of this study is to investigate clinical feasibility and significance of RV vortex flow analysis using CE in predicting hemodynamics and symptomatic status in patients with PH. Methods: 15 patients with PH (PA pressure ���70mmHg, 8 with symptom and 7 without symptom) underwent 2-D CE with slow infusion of Definity and imaged at mechanical index of 0.5-0.8 in the parasternal short axis (PSX) and apical 4 chamber(A4C) views. We measured morphology parameters (vortex length, width, and sphericity index) and pulsatility parameters (Relative strength, RS) of RV vortex. We performed 6-min walk distance (mWD) and right heart cath (RV dP/dt, pulmonary vascular resistance(PVR)) in all patients. Results: There were no significant difference in RV dimension and volume measured by 2-D echo, and in vortex morphology parameters between two groups. However, RS was significantly higher in asymptomatic than symptomatic group (1.8짹0.5 vs 1.2짹0.6, P=0.01). RV vortex pulsatility parameter RS was well correlated with mWD and PVR (mWD, r = 0.513, p<0.01, PVR, r=-0.608, p<0.01, respectively). Figure (upper panel) shows echo freeze frame of short axis (A) and apical 4 chamber view (B), lower panel represents averaged flow path with velocity vectors superimposed on vorticity color-map (Lt) and pulsatility map (Rt). Conclusion: It is feasible to characterize RV vortex flow using CE. RV vortex flow parameters were well correlated with RV function and exercise capacity in patients with severe PH. Furthermore RV vortex flow parameters were incremental to conventional echo-Doppler measurements to predict symptomatic status in patients with PH and may offer a new method for early detection of RV dysfunction.