From the Guidelines
Elevated Right Ventricular Systolic Pressure (RVSP) is a strong indicator of pulmonary hypertension (PH), a condition characterized by high blood pressure in the arteries that supply blood to the lungs.
Key Points
- An RVSP > 45 mmHg is considered elevated and warrants a comprehensive pulmonary hypertension workup 1.
- Even mildly elevated PA pressures are associated with evidence of right ventricular dysfunction, which can lead to poor outcomes 1.
- The average pulmonary artery systolic pressure (PASP) in healthy individuals is around 21 ± 4 mm Hg, with an upper limit of around 30 mm Hg 1.
- An ePASP of > 30 mm Hg is considered abnormal and may indicate PH, even if it's below the traditional threshold of 40 mm Hg 1.
- RVSP is estimated using Doppler echocardiography, which measures the velocity of the tricuspid jet and calculates the right ventricular/right atrial pressure gradient during systole 1.
Clinical Implications
- Elevated RVSP can lead to right ventricular dysfunction and failure, which can be fatal if left untreated 1.
- A comprehensive workup for PH includes a physical exam, medical history, laboratory tests, and imaging studies such as echocardiography and right heart catheterization 1.
- Treatment for PH depends on the underlying cause and severity of the disease, but may include medications such as calcium channel blockers, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors 1.
From the Research
Elevated Right Ventricular Systolic Pressure (RVSP) Indications
Elevated RVSP is an indicator of various cardiovascular conditions, including:
- Pulmonary hypertension (PH) 2, 3, 4, 5
- Right ventricular dysfunction 6
- Increased risk of hospitalization and mortality in patients with chronic heart failure 2
- Adverse outcomes, including higher Charlson Comorbidity Index and increased hospitalization rates 3
RVSP Measurement and Prediction
RVSP measurements can be used to:
- Estimate pulmonary arterial pressure 4
- Predict the presence of PH in patients with idiopathic pulmonary fibrosis, although its accuracy is limited 5
- Identify patients at increased risk of cardiovascular events, such as hospitalization and mortality 2, 3
- Assess right ventricular systolic function, which is a major determinant of prognosis in patients with PH 6
Clinical Significance of Elevated RVSP
Elevated RVSP is associated with:
- Increased risk of hospitalization and mortality in patients with chronic heart failure 2
- Adverse outcomes, including higher Charlson Comorbidity Index and increased hospitalization rates 3
- Right ventricular dysfunction and decreased ejection fraction 6
- Pulmonary hypertension, which can have a significant impact on patient outcomes 3, 5