Has the study been reviewed to see if the measurements of right ventricular systolic pressure (RVSP) or pulmonary hypertension were accurate and not just artifact or error? If your echo report says you have elevated RVSP or evidence to suggest pulmonary hypertension, the following questions may be useful to ask. Questions to Ask Your Physician About Your RVSP For example in a patient with valve disease and pulmonary hypertension, the most important thing would be to treat the valve such as a TAVR procedure or a Mitraclip. In secondary pulmonary hypertension treatment is typically aimed at the underlying cause. ![]() Other causes include chronic conditions such as sleep apnea, blood clots in the lungs, lungs disease, lupus, living at altitude, and others. The most common cause is left sided heart failure such as that seen with valvular heart disease like mitral regurgitation or aortic stenosis or congestive heart failure. In secondary pulmonary hypertension the high pressures are attributed to other causes. In primary pulmonary hypertension an underlying cause if often not found for the high pressures in the lungs. Primary pulmonary hypertension is less common than secondary. This is split in to primary and secondary causes. What Are Some Causes of Elevated Right Ventricular Systolic Pressure (RVSP)? ![]() Also, it’s important that the RVSP value isn’t taken in isolation when suggesting a diagnosis of pulmonary hypertension, rather multiple supporting echocardiographic findings should be taken together. For this reason, conclusions from echocardiography should be limited to classifying patients as having a certain probability of having pulmonary hypertension rather than making a certain diagnosis. Also multiple numbers such as RVSP are being put in to formulas, so any errors will be greater multiplied. It’s very important to remember that echocardiography is not an exact science and there are many limitations to measurements obtained. ![]() The RVSP and Pulmonary Artery Pressure Estimate from Echo Are Not Perfect In general however, an estimated pulmonary artery pressure greater than 40 from the echocardiogram suggests a mean pulmonary artery pressure > 25 and therefore pulmonary hypertension. This means that it gives a highest value rather than an average. Remember though that the right ventricular systolic pressure estimate on the echocardiogram gives a peak and not a mean pressure. Mild pulmonary hypertension is generally in the 25-40 range, moderate is in the 41-55 range, and severe is the >55 range. A normal mean pulmonary artery pressure is 12-16. Pulmonary hypertension is typically assessed based on a mean value that is generally an average of its highest and lowest points. The number given estimates the pressure in units of mmHg (millimeters of mercury). Therefore on the echo report the more important measurement is the estimated pulmonary artery pressure. The RVSP is important because it allows estimation of the pulmonary artery pressure. How to Interpret Your Right Ventricular Systolic Pressure (RVSP) from the echo? The formula also requires a measurement of the right atrial pressure, which is estimated by looking at the size of the inferior vena cava on the echocardiogram. This measurement is placed into a formula and an estimate of the RVSP is obtained, which also reflects the pulmonary artery pressure. The velocity across the tricuspid valve is proportional to the RVSP. The leak is known as tricuspid regurgitation and the measurement that is important is the tricuspid regurgitation (TR) velocity. ![]() The pressure generated by the right side is reflected in measurements of this leak. When the right side of the heart pumps, most people have a little leak back through the right sided heart valve known as the tricuspid valve. The higher the pressure in the pulmonary artery, the higher the pressure the right heart has to generate, which basically means the higher the RVSP. The right side of the heart has to pump into the lungs through a vessel called the pulmonary artery. RVSP basically is the pressure generated by the right side of the heart when it pumps. RV is right ventrical and RA is right atrium. Tricuspid regurgitation (TR) on echocardiogram.
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