From the Guidelines
Right ventricular systolic pressure (RVSP) greater than 45 mmHg on echocardiography is used to diagnose pulmonary hypertension, as it suggests an elevated pulmonary artery systolic pressure. RVSP is typically measured using Doppler echocardiography by calculating the peak tricuspid regurgitation velocity and applying the modified Bernoulli equation, then adding the estimated right atrial pressure 1. This provides an estimate of pulmonary artery systolic pressure, which correlates with pulmonary hypertension when elevated. However, it's essential to note that while RVSP measurement by echocardiography is a useful screening tool, definitive diagnosis of pulmonary hypertension requires right heart catheterization, which directly measures mean pulmonary artery pressure (mPAP) 1. Pulmonary hypertension is definitively diagnosed when mPAP is ≥25 mmHg at rest during right heart catheterization. Echocardiographic RVSP estimation is valuable for initial screening and monitoring but has limitations in accuracy compared to the gold standard invasive measurement.
Some key points to consider when using RVSP to diagnose pulmonary hypertension include:
- The accuracy of RVSP measurement can be affected by various factors, such as the presence of pulmonic valve stenosis or outflow tract obstruction 1.
- The modified Bernoulli equation is used to estimate RVSP, and the result is derived by adding the estimated right atrial pressure to the gradient calculated from the tricuspid regurgitation velocity 1.
- A comprehensive workup, including a full set of pulmonary function tests, six-minute walk test, and non-contrast CT scan of the chest or CT angiogram, is necessary to characterize the disease phenotype and rule out other potential causes of symptoms 1.
- Right heart catheterization is essential for definitive diagnosis and should be performed after a comprehensive workup is complete 1.
In clinical practice, a RVSP greater than 45 mmHg on echocardiography should prompt further evaluation for pulmonary hypertension, including a comprehensive workup and right heart catheterization, to confirm the diagnosis and guide management decisions 1.
From the Research
RVSP Diagnoses for Pulmonary Hypertension
- RVSP estimation by echocardiography is used to screen for pulmonary hypertension (PH) 2
- A model including RVSP, right atrial enlargement, pulmonary artery enlargement, right ventricular enlargement, and right ventricular dysfunction had a higher area under the curve (AUC) than RVSP alone for diagnosing PH 2
- RVSP ≥40 mmHg had a sensitivity of 77% and accuracy of 77% for diagnosing PH, while RVSP ≥35 mmHg had the highest sensitivity at 88% and accuracy of 81% 2
Thresholds for RVSP
- RVSP ≥36 mmHg was associated with increased mortality in patients with scleroderma 3
- RVSP ≥40 mmHg is the current guideline-recommended threshold for evaluating echocardiographically estimated right ventricular systolic pressure 4
- An increase in adjusted mortality began at an RVSP value of 27 mmHg 4
Prognostic Value of RVSP
- RVSP was independently associated with hospitalization and mortality in patients with heart failure 5
- RVSP measurements identify patients at increased risk who may require more-aggressive monitoring and medical therapy 5
- A larger RV diameter was a marker of poor prognosis in patients with idiopathic pulmonary arterial hypertension 6