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Most commonly, PA stiffness is estimated by calculation of pulmonary arterial capacitance as ratio of stroke volume over pulmonary pulse pressure, assessed by either cardiac catheterization or non-invasively by echocardiography (20, 30–37), or by calculation of a stiffness index as change in PA pressure (again assessed by right heart catheterization) divided by the corresponding change in PA diameter (determined by real-time imaging modalities, such as cardiac magnetic resonance imaging) (18, 38)