Normal Values for Right Ventricular Systolic Pressure (RVSP)
The normal right ventricular systolic pressure (RVSP) is less than 35 mm Hg, with an upper limit of normal considered to be 30-35 mm Hg in adults. 1
Age-Related Normal RVSP Values
- In healthy individuals, the average RVSP measured by right heart catheterization is approximately 21 ± 4 mm Hg, with an upper limit around 30 mm Hg 1
- RVSP remains relatively stable until age 50, then increases progressively with age 2:
- Age < 50 years: 27.3 ± 5.7 mm Hg (normal range 16-39 mm Hg)
- Age 50-75 years: 30.2 ± 7.6 mm Hg (normal range 15-45 mm Hg)
- Age > 75 years: 34.8 ± 8.7 mm Hg (normal range 17-52 mm Hg)
RVSP Measurement and Interpretation
- RVSP is calculated using the modified Bernoulli equation: RVSP = 4v² + RAP, where v is the peak velocity of the tricuspid regurgitation jet in meters per second, and RAP is the estimated right atrial pressure 1
- RAP can be estimated based on inferior vena cava (IVC) diameter and respiratory variation 1:
- IVC diameter < 2.1 cm with > 50% collapse during sniff: RAP ≈ 3 mmHg (range 0-5 mmHg)
- IVC diameter > 2.1 cm with < 50% collapse: RAP ≈ 15 mmHg (range 10-20 mmHg)
- Intermediate cases: RAP ≈ 8 mmHg (range 5-10 mmHg)
Clinical Significance of RVSP Values
- RVSP < 35 mm Hg: Normal 1
- RVSP 35-40 mm Hg: Borderline elevated 1
- RVSP 40-49 mm Hg: Mildly elevated 3
- RVSP 50-59 mm Hg: Moderately elevated 3
- RVSP ≥ 60 mm Hg: Severely elevated 3
Important Considerations
- Elevated RVSP > 30 mm Hg is associated with increased mortality risk, even below the traditional threshold of 40 mm Hg used to suggest possible pulmonary hypertension 1
- RVSP measurements may be unreliable in patients with severe tricuspid regurgitation (can underestimate true pressure) 1
- RVSP measurements may overestimate pressure in patients with tubular stenosis or stenoses in series 1
- Tricuspid regurgitation jets are analyzable in 39-86% of patients; absence of a measurable jet does not rule out elevated pulmonary pressure 1
Prognostic Implications
- Even mildly elevated RVSP (40-49 mm Hg) is independently associated with increased risk of heart failure hospitalization and all-cause mortality (HR 1.31) compared to normal RVSP 3
- Moderately elevated RVSP (50-59 mm Hg) carries higher risk (HR 1.54) 3
- Severely elevated RVSP (≥60 mm Hg) has the highest risk (HR 1.92) 3
- The TAPSE/RVSP ratio (tricuspid annular plane systolic excursion divided by RVSP) is a useful measure of right ventricular-pulmonary arterial coupling and can help identify patients at risk for right ventricular dysfunction 4
When to Consider Intervention
- In patients with right ventricular outflow tract obstruction, intervention should be considered when the Doppler peak gradient is >64 mm Hg (peak velocity >4 m/s) regardless of symptoms 1
- In asymptomatic patients with valvular pulmonary stenosis where surgical valve replacement is the only option, surgery should be performed when systolic RV pressure >80 mm Hg (TR velocity >4.3 m/s) 1