Normal RVSP Values on Echocardiography
RVSP less than 30 mm Hg is considered within normal limits, with values above 30 mm Hg falling outside the healthy range and associated with increased mortality risk. 1
Defining Normal RVSP
- The upper limit of normal RVSP is 30-35 mm Hg, with most guidelines converging on 30 mm Hg as the threshold separating normal from abnormal values 2
- In healthy individuals measured by right heart catheterization, average RVSP is 21 ± 4 mm Hg, with the upper limit around 30 mm Hg 1
- Echocardiographic measurements in healthy populations show average RVSP in the teens to low-20s mm Hg range, with values above 30 mm Hg being uncommon 1
Important Exceptions to Normal Values
The following populations may have RVSP values above 30 mm Hg without pathology:
- Young well-trained athletes 1
- High-altitude residents 1
- Elderly patients (RVSP increases modestly with age due to pulmonary vascular stiffening, though elevated values remain prognostically significant even after age adjustment) 1
Clinical Significance of RVSP Categories
Normal Range
- RVSP < 30 mm Hg: Optimal/healthy pulmonary pressure 1
- RVSP < 35 mm Hg: Considered normal by some guidelines 2
Borderline/Mildly Elevated
- RVSP 30-35 mm Hg: Outside normal range but below traditional PH threshold 1, 2
- RVSP 35-40 mm Hg: Borderline elevated 2
- Even mildly elevated RVSP (30-32 mm Hg) carries significant prognostic implications, with five-year mortality of 28.9% in clinical populations 1
Elevated
- RVSP 40-49 mm Hg: Mildly elevated, associated with increased risk 3
- RVSP 50-59 mm Hg: Moderately elevated 3
- RVSP ≥ 60 mm Hg: Severely elevated 3
Critical Clinical Pitfalls
The traditional threshold of 40 mm Hg for "concerning" pulmonary hypertension is outdated and misses high-risk patients. 1 Values above 30 mm Hg warrant clinical attention:
- Mortality risk increases by approximately 40% for every 10 mm Hg rise in RVSP 1, 4
- RVSP > 30 mm Hg is present in over 40% of clinical echocardiograms and 25% of population-based samples 1
- One-year mortality with RVSP 30-32 mm Hg is 10.1% in clinical populations 1
Measurement Reliability Considerations
- RVSP can be measured in approximately two-thirds of all echocardiograms (tricuspid regurgitation jets analyzable in 39-86% of patients) 2
- Absence of a measurable tricuspid regurgitation jet does not rule out elevated pulmonary pressure 1, 2
- Measurements may be unreliable with severe tricuspid regurgitation (can underestimate true pressure) 2
- In one study of IPF patients, only 40% of RVSP estimates accurately reflected catheterization values 5
When RVSP Cannot Be Measured
Look for indirect signs of elevated pulmonary pressure: