Is a right‑ventricular systolic pressure of ≤30 mm Hg on transthoracic echocardiography normal for a 65‑year‑old woman, and does it require any treatment or further evaluation?

Normal RVSP in a 65-Year-Old Female

A right ventricular systolic pressure (RVSP) of ≤30 mm Hg is considered normal and optimal for a 65-year-old woman, though values up to 35 mm Hg may be seen in healthy elderly individuals. 1, 2

Understanding Normal Values in This Age Group

The healthy range for RVSP is narrower than traditionally recognized:

• In healthy individuals measured by right heart catheterization, average RVSP is 21 ± 4 mm Hg, with an upper limit around 30 mm Hg 1
• While RVSP increases modestly with age due to increased pulmonary vascular stiffness, values >30 mm Hg cannot be dismissed as "normal aging" because they independently predict increased mortality even after age adjustment 1
• The American Heart Association recognizes RVSP <35 mm Hg as normal, with 35-40 mm Hg considered borderline elevated 2

Age-Specific Considerations

For patients over 50 years old, slightly higher values may be encountered but remain prognostically significant:

• Among echocardiographically normal subjects >50 years old, 6% had RVSP >40 mm Hg 3
• In a large cohort of healthy subjects, PASP values were significantly higher in those aged >50 years, with 8% having values >40 mm Hg 4
• However, even "mildly elevated" RVSP of 30-32 mm Hg carries 28.9% five-year mortality and 10.1% one-year mortality 1

Clinical Implications for Values ≤30 mm Hg

An RVSP ≤30 mm Hg requires no specific treatment or further evaluation in an asymptomatic patient:

• This value falls within the optimal healthy range 1, 2
• No pulmonary hypertension workup is indicated 1
• Routine follow-up echocardiography is not necessary based solely on this finding

When Further Evaluation IS Needed

Even with RVSP ≤30 mm Hg, additional assessment is warranted if:

• The patient has unexplained dyspnea, syncope, or exercise intolerance despite normal RVSP 1
• Other echocardiographic signs suggest pulmonary hypertension: right ventricular hypertrophy, dilation, dysfunction, short pulmonary acceleration time, or notching in the right ventricular outflow tract Doppler 1
• Absence of a measurable tricuspid regurgitation jet does not rule out elevated pulmonary pressures, so clinical suspicion should guide further testing 1

Important Measurement Caveats

Ensure the RVSP measurement is reliable:

• RVSP is calculated as 4v² + RAP, where v is peak tricuspid regurgitation velocity and RAP is estimated right atrial pressure 2
• RAP estimation based on inferior vena cava diameter and collapsibility significantly affects the final RVSP value 2, 5, 6
• Tricuspid regurgitation jets are analyzable in only 39-86% of patients; poor signal quality can lead to inaccurate measurements 2, 7
• Level 3 echocardiography readers consider only 61% of TR signals truly interpretable, compared to 72% in routine clinical reports 7