From the Guidelines
Yes, isolated elevated Right Ventricular Systolic Pressure (RVSP) can occur without pulmonary hypertension.
Key Points
- Elevated RVSP is not always synonymous with pulmonary hypertension, as it can be influenced by various factors such as tricuspid regurgitation, pulmonary valve stenosis, or other conditions affecting the right heart 1.
- The diagnosis of pulmonary hypertension requires a comprehensive evaluation, including right heart catheterization, to determine the mean pulmonary arterial pressure (mPAP) and to rule out other causes of elevated RVSP 1.
- The American College of Radiology (ACR) Appropriateness Criteria for suspected pulmonary hypertension emphasize the importance of a careful history, physical examination, and diagnostic testing, including echocardiography and right heart catheterization, to establish an accurate diagnosis 1.
- Isolated elevated RVSP can be seen in various conditions, such as tricuspid regurgitation, pulmonary valve stenosis, or other right heart diseases, without necessarily indicating pulmonary hypertension 1.
Diagnostic Considerations
- Echocardiography is a useful initial test for evaluating RVSP and estimating pulmonary artery pressure, but it may not always provide accurate measurements, especially in patients with severe pulmonary hypertension or those with complex cardiac anatomy 1.
- Right heart catheterization remains the gold standard for diagnosing pulmonary hypertension and assessing the severity of the disease 1.
- A comprehensive diagnostic approach, including clinical evaluation, laboratory testing, and imaging studies, is essential for establishing an accurate diagnosis and guiding management decisions in patients with suspected pulmonary hypertension 1.
From the Research
Isolated Elevated Right Ventricular Systolic Pressure (RVSP) without Pulmonary Hypertension
- The relationship between RVSP and pulmonary hypertension (PH) is complex, and elevated RVSP does not always indicate PH 2, 3, 4, 5, 6.
- Studies have shown that RVSP can be elevated in patients without PH, and that the accuracy of RVSP in predicting PH is limited 2, 5.
- For example, a study found that an optimal RVSP threshold for screening PH could not be detected, and that RVSP was not an accurate test for assessing PH in patients with idiopathic pulmonary fibrosis 2.
- Another study found that RVSP measurements identified patients at increased risk of hospitalization and mortality, but that improving RVSP was associated with increased risk, suggesting that RVSP may not always be a reliable indicator of PH 3.
- Additionally, a study found that pulmonary hypertension was infrequently mentioned in echocardiography reports of patients with RVSP >40 mm Hg, and that referral to a PH clinic was rare, even among patients with elevated RVSP 4.
- A study using cardiac MR imaging-derived left ventricular septal-to-free wall curvature ratio found that this method was accurate and reproducible for estimating RVSP, but did not directly address the question of whether isolated elevated RVSP can occur without PH 5.
- A retrospective cohort study found that patients with elevated RVSP (≥ 30 mm Hg) had higher Charlson Comorbidity Index and hospitalization rates, but that most patients with elevated RVSP were not reported as having PH or investigated, suggesting that the significance of elevated RVSP is underappreciated 6.