From the Guidelines
A dilated right ventricle (RV) and a right ventricular systolic pressure (RVSP) of 36 mmHg are consistent with mild pulmonary hypertension, as RVSP values above 35 mmHg suggest the condition, according to the most recent and highest quality study 1. Pulmonary hypertension is typically defined as a mean pulmonary artery pressure ≥25 mmHg at rest. The RV dilation is a compensatory mechanism that occurs as the right ventricle works harder against increased pulmonary vascular resistance.
Key Considerations
- The diagnosis of pulmonary hypertension is suspected when systolic pulmonary artery pressure is higher than 30 mmHg on echocardiography and should be confirmed by right heart catheterization, as stated in 1.
- Moderate and severe pulmonary hypertension are associated with increased mortality, and early diagnosis and therapy with pulmonary vasodilators are crucial, as noted in 1.
- A comprehensive workup, including right heart catheterization, is necessary to confirm the diagnosis and classify the type of pulmonary hypertension, which will guide appropriate treatment, as discussed in 1.
Recommendations
- Further evaluation is warranted to determine the underlying cause of the pulmonary hypertension, which could include left heart disease, lung disease, chronic thromboembolic disease, or primary pulmonary arterial hypertension.
- Additional testing, such as right heart catheterization, should be performed to confirm the diagnosis and classify the type of pulmonary hypertension.
- Early intervention is important because chronic pressure overload can eventually lead to right heart failure if left untreated, as emphasized in 1.
Important Findings
- The study 1 highlights the importance of early diagnosis and therapy with pulmonary vasodilators in patients with pulmonary hypertension.
- The study 1 discusses the comprehensive workup necessary to confirm the diagnosis and classify the type of pulmonary hypertension.
- The study 1 emphasizes the importance of assessing pulmonary artery pressure in individuals with tricuspid regurgitation and considering right heart catheterization when there is a high index of suspicion for pulmonary hypertension.
From the Research
Definition of Pulmonary Hypertension
Pulmonary hypertension (Pulm HTN) is defined by a mean pulmonary artery pressure greater than 20 mm Hg 2. It is classified into 5 clinical groups based on etiology, pathophysiology, and treatment.
Diagnosis of Pulmonary Hypertension
The golden standard for diagnosis of PH is right heart catheterization, however, evidence of PH can be appreciated on clinical examination, serology, radiological imaging, and Doppler echocardiography 3.
Right Ventricle Systolic Pressure (RVSP) and Pulmonary Hypertension
A RVSP of 36mmHg is consistent with pulmonary hypertension, as it indicates increased pressure in the pulmonary arteries 4, 2.
Dilated Right Ventricle (RV) and Pulmonary Hypertension
A dilated right ventricle is a common finding in patients with pulmonary hypertension, and is associated with poor prognosis and may progress to right heart failure 3, 5.
Key Points
- A RVSP of 36mmHg is consistent with pulmonary hypertension.
- A dilated right ventricle is a common finding in patients with pulmonary hypertension.
- Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 20 mm Hg.
- The golden standard for diagnosis of PH is right heart catheterization.
- A dilated pulmonary artery is a common finding in patients with pulmonary arterial hypertension (PAH) 4.
RV Systolic Pressure and Pulmonary Artery Diameter
An increase in main PA diameter is associated with higher right ventricular (RV) systolic pressure, worse RV function and a decline in 6-min walk distance 4.
Prognostic Relevance of RV-PA Coupling
RV-PA coupling, as measured by the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary arterial pressure (sPAP) ratio, is a prognostic factor in patients with suspected PH, even in those with normal or mildly elevated resting mean pulmonary arterial pressure (mPAP) 6.