What is the normal range for Right Ventricular Systolic Pressure (RVSP)?

From the Guidelines

The normal range for right ventricular systolic pressure (RVSP) is typically less than 35 mmHg in adults at rest, as stated in the 2008 ACC/AHA guidelines for the management of adults with congenital heart disease 1. RVSP is an important hemodynamic parameter that reflects the pressure generated by the right ventricle during contraction. It is commonly measured using echocardiography by estimating the tricuspid regurgitation jet velocity and applying the modified Bernoulli equation, then adding the estimated right atrial pressure. Values above 35-40 mmHg are generally considered elevated and may indicate pulmonary hypertension or other cardiovascular conditions affecting the right side of the heart. Some studies suggest that a RVSP above 45 mmHg may initiate a comprehensive pulmonary hypertension workup 1. However, the 2008 guidelines provide a more specific and direct definition of the normal range for RVSP. RVSP can be influenced by various factors including age, body position, altitude, and underlying cardiac or pulmonary conditions. Regular monitoring of RVSP is important in patients with suspected right heart dysfunction, pulmonary hypertension, or congenital heart disease to guide diagnosis and treatment decisions. The estimation of RVSP using Doppler echocardiography has been shown to be reliable, with correlation coefficients between RVSP estimated from tricuspid regurgitation and hemodynamic right-heart catheterization values ranging from 0.57 to 0.95 1. However, the 2008 guidelines provide the most direct and relevant information for determining the normal range for RVSP. In clinical practice, it is essential to consider the individual patient's condition and medical history when interpreting RVSP values. Overall, a RVSP of less than 35 mmHg is considered normal, and values above this range may indicate the need for further evaluation and treatment.

From the Research

Normal Range of RVSP

The normal range of right ventricular systolic pressure (RVSP) can vary depending on age and other factors.

• According to a study published in The Canadian journal of cardiology 2, the mean resting and peak exercise RVSP was 27.8+/-7.8 mmHg and 34.8+/-11.3 mmHg in men, and 27.8+/-7.7 mmHg and 34.6+/-11.7 mmHg in women, respectively.
• The 95% CI for peak RVSP was 12.2 mmHg to 57.4 mmHg in men, and 11.2 mmHg to 58.0 mmHg in women.
• Another study published in The Canadian journal of cardiology 3 found that RVSP increases significantly only after the age of 50 years, with a mean (+/- SD) RVSP of 27.3+/-5.7 mmHg, 30.2+/-7.6 mmHg, and 34.8+/-8.7 mmHg for those younger than 50 years, 50 to 75 years, and older than 75 years of age, respectively.
• The normal range (95% CI) of RVSP in those younger than 50 years, 50 to 75 years, and older than 75 years of age was 16 mmHg to 39 mmHg, 15 mmHg to 45 mmHg, and 17 mmHg to 52 mmHg, respectively.

Factors Influencing RVSP

Several factors can influence the echocardiographic estimate of RVSP, including:

• Age: RVSP increases progressively and normally with age 3.
• Mitral diastolic early-to-late filling velocity ratio: Multivariate analysis indicated that this factor is a significant independent variable influencing RVSP 3.
• Ejection fraction: This factor is also a significant independent variable influencing RVSP 3.
• Aortic size: A larger aortic size is associated with higher RVSP 3.
• Early mitral filling velocity/early diastolic mitral annular velocity: This factor is also a significant independent variable influencing RVSP 3.

Clinical Significance of RVSP

RVSP is an important parameter in the diagnosis and management of pulmonary hypertension and right ventricular failure.

• A study published in Current opinion in cardiology 4 found that pulmonary hypertension and right ventricular failure in left ventricular systolic dysfunction is associated with high morbidity and mortality.
• Another study published in American journal of physiology. Lung cellular and molecular physiology 5 found that RV pressure-volume loop shape and systolic pressure change can reflect PAH severity and RV function.