AbstractBackgroundPulmonary stenosis (PS) usually is evaluated using echocardiography. A multiparametric approach, in addition to the maximum pressure gradient (PG), might be indicated to better characterize PS severity and address its management.Hypothesis/ObjectivesOur hypothesis was that right heart size and function are associated with echocardiographic and clinical severity of pulmonary stenosis in dogs.AnimalsClient‐owned dogs with PS.MethodsProspective, multicenter, observational study. Enrolled dogs underwent complete echocardiographic examination. Associations among right heart echocardiographic variables, PS transvalvular PG >80 mm Hg and presence of clinical signs (exercise intolerance, syncope, right‐sided congestive failure, or some combination of these) were assessed using logistic regression analysis.ResultsEighty‐eight dogs with PS. Twenty‐eight dogs were symptomatic. Increased right ventricular end‐diastolic free wall thickness (odds ratio [OR] > 100; 95% confidence interval [95%CI], 50‐ > 100;P= .01) and decreased aorta‐to‐pulmonary artery velocity time integral ratio (OR, < 0.001; 95%CI, 0.0‐0.001;P= .005) were independently associated with PS PG >80 mm Hg. Decreased tricuspid annular plane systolic excursion (OR, 0.35; 95%CI, 0.15‐0.77;P= .01) and increased right ventricular end‐diastolic area (OR, 1.4; 95%CI, 1.08‐2.02;P= .01) were independently associated with clinical severity.Conclusion and Clinical ImportanceStructural and functional right heart echocardiographic variables are associated with echocardiographic and clinical severity in dogs with PS. A multiparametric approach is advised to better assess PS severity.