Echocardiographic Findings Interpretation
These echocardiographic results are entirely normal and indicate no pulmonary hypertension, no significant tricuspid regurgitation, and normal right heart pressures. The tricuspid regurgitation peak velocity of 2.4 m/s falls well within the normal range and requires no further investigation or intervention in the absence of other concerning findings.
Right Ventricular Systolic Pressure Assessment
The RV peak systolic pressure of 26 mmHg is completely normal. This value represents the estimated pulmonary artery systolic pressure (PASP) calculated as: tricuspid regurgitation pressure gradient (20.93 mmHg) + estimated right atrial pressure (3 mmHg) = approximately 24 mmHg, which rounds to the reported 26 mmHg 1.
Normal PASP is less than 35 mmHg at rest, and values below 30 mmHg are definitively within the normal range 1, 2. The patient's value of 26 mmHg is well below this threshold.
The tricuspid regurgitation peak gradient of 20.93 mmHg also falls within the normal range, as the upper normal limit for tricuspid gradient is 30 mmHg 2.
Tricuspid Regurgitation Velocity Analysis
The TR peak velocity of 2.4 m/s is normal and carries no increased mortality risk. According to current guidelines, TR velocity less than 2.5 m/s is considered normal 3.
For pulmonary hypertension screening, this patient falls into the "low probability" category, as the peak tricuspid regurgitation velocity is less than 2.8 m/s 1. Low probability for pulmonary hypertension is defined as peak tricuspid regurgitation velocity ≤2.8 m/s without additional echocardiographic signs suggestive of pulmonary hypertension 1.
The American Thoracic Society confirms that TR velocity ≥2.5 m/s is the threshold for elevated values associated with increased mortality risk 3. This patient's value of 2.4 m/s falls below this threshold.
Right Atrial Pressure Estimation
The estimated right atrial pressure of 3 mmHg is normal and suggests excellent right heart hemodynamics. This low value indicates no venous congestion and normal right atrial filling pressures 1.
This low right atrial pressure estimate is consistent with a normal inferior vena cava diameter with appropriate respiratory collapse 1.
Clinical Significance in Context of Renal Impairment
Despite the patient's impaired renal function, these echocardiographic findings do not suggest cardiorenal syndrome from right heart dysfunction. Significant tricuspid regurgitation (moderate or severe) contributes to renal dysfunction through elevation of central and renal venous pressure 4, 5, but this patient has only trivial/mild TR based on the velocity.
The combination of normal right heart pressures and normal TR velocity effectively excludes right-sided heart failure as a contributor to the renal dysfunction 4, 5, 6. The renal impairment must be attributed to other causes (intrinsic renal disease, left ventricular dysfunction, medications, etc.).
Recommendations
No further cardiac workup is needed based on these right heart findings alone. The values are entirely within normal limits 1, 3, 2.
Focus the evaluation of renal dysfunction on non-cardiac causes, including intrinsic renal disease, nephrotoxic medications, volume status, and left ventricular function if not already assessed 4, 5.
Routine follow-up echocardiography is not indicated based solely on these normal right heart parameters, unless clinically indicated for other reasons (left ventricular assessment, valvular disease, etc.) 1, 3.