EchocardiographyExercise StressMiscEchocardiography
Aortic Valve Velocity RatioLV EF (Modified Quinones Equation)Myocardial Performance Index (RV)
AVA (Continuity Equation VTI)LV EF (Simplified Quinones Equation)PCWP by E/Ea (Nagueh Formula)
AVA (Continuity Equation VMax)LV Fractional ShorteningPISA (Mitral regurgitation)
dP/dt (LV contractility)LV Mass and LV Mass IndexPISA (Mitral stenosis)
dP/dt (RV contractility)Mitral valve area (PHT)Qp/Qs
Left atrial pressure (MR)Mitral Valvuloplasty Score (MGH)RVSP (TR)
LA Volume (Biplane Method)Modified Bernoulli EquationStroke Volume, Cardiac Output
LV EF (Dumesnil Method)Myocardial Performance Index (LV)
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RVSP estimation by Tricuspid Regurgitation Jet

Calculation


TR VMax m/s
IVC Diameter
Collapse with Sniff
RA Pressure mmHg


RVSP mmHg
Calculate

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Information

Right ventricular systolic pressure (RVSP) can be estimated by measuring the TR jet maximum velocity by continuous wave (CW) spectral Doppler. If there is no significant stenosis at the right ventricular outflow tract, or the pulmonic valve, the RVSP is equivalent to the systolic pulmonary artery pressure (SPAP).

The RA pressure (RAP) can be estimated by the size and respiratory collapsibility of the inferior vena cava. For simplicity and uniformity of reporting, specific values of RAP, rather than ranges, should be used in the determination of RVSP.

IVC Diameter Collapse with Sniff RA Pressure (mmHg)
≤21 mm >50 % Normal 3 (0-5)
Intermediate Intermediate Intermediate 8 (5-10)
>21 mm <50 % High 15 (10-20)

Secondary indices of elevated RA pressure include:

  1. Restrictive filling
  2. Tricuspid E/E' >6
  3. Diastolic flow predominance in hepatic vein (HV) i.e. HV systolic filling fraction Vs/(Vs+Vd) <55%

In young athletes, IVC may be dilated in the presence of normal pressure. IVC is commonly dilated and may not collapse in patients on ventilators, so it should not be used in such cases to estimate RA pressure.

Normal resting values are usually defined as a peak TR gradient of 2.8 to 2.9 m/s or a peak systolic pressure of 35 to 36 mmHg, assuming an RA pressure of 3 to 5 mmHg. SPAP may increase with age and increasing body surface area and this should be considered when estimations are at the upper limits of normal. Some cardiologists who care for patients with congenital heart disease will consider SPAP greater than two thirds of the systemic blood pressure as indicative of severe pulmonary hypertension.

RVSP = 4(TR VMax)2 + RA pressure

Variable Definition
TR VMax TR Max Jet Velocity (m/sec)
RA Pressure Choose between 3, 8, or 15 mmHg, or other (mmHg)
RVSP Right ventricular systolic pressure (mmHg)

References

Rudski LG, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):687-8, 691-2, 698-9.
Yock PG, et al. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984; 70(4):657-62.
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