BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAP_M) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAP_M in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRV_max). METHODS. PAP_M was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAP_M were assessed. Diagnostic performance of DE methods vs. TRV_max=2.8m/sec to identify invasive PAP_M ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAP_M, with relatively lower mean bias and higher precision observed in algorithms that included TRV_max or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRV_max (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAP_M demonstrate reasonable accuracy to represent invasive PAP_M and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRV_max. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.