What is RVSP?
RVSP is short for right ventricular systolic pressure. RVSP is a commonly searched term because it is found on almost all echocardiogram reports. It is important as the RVSP is used to estimate the pressure inside the artery that supplies the lung with blood. In most cases, the RVSP equals the pulmonary artery pressure. Elevated pressures in the pulmonary artery is known as pulmonary artery hypertension, a condition that may require close attention and treatment.
How is RVSP Measured?
The gold standard way for obtaining the right ventricular systolic pressure (RVSP) and the pulmonary artery pressure is an invasive test called a heart catheterization. In a heart catheterization small tubes are passed into the heart chambers and measurements taken. Echocardiography can be used to estimate the RVSP and importantly provides a non-invasive way of doing so. Echocardiography is therefore an excellent way of identifying people with elevated RVSP and pulmonary hypertension and therefore selecting those candidates that may benefit from treatment and sometimes confirmation of the diagnosis with heart catheterization.
How is RVSP Measured? – Getting a Bit More Technical
RVSP basically is the pressure generated by the right side of the heart when it pumps. The right side of the heart has to pump into the lungs through a vessel called the pulmonary artery. 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. 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 pressure generated by the right side is reflected in measurements of this leak. The leak is known as tricuspid regurgitation and the measurement that is important is the tricuspid regurgitation (TR) velocity. The velocity across the tricuspid valve is proportional to the RVSP. This measurement is placed into a formula and an estimate of the RVSP is obtained, which also reflects the pulmonary artery pressure. 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.
How to Interpret Your Right Ventricular Systolic Pressure (RVSP) from the echo?
The RVSP is important because it allows estimation of the pulmonary artery pressure. Therefore on the echo report the more important measurement is the estimated pulmonary artery pressure. The number given estimates the pressure in units of mmHg (millimeters of mercury).
Pulmonary hypertension is typically assessed based on a mean value that is generally an average of its highest and lowest points. A normal mean pulmonary artery pressure is 12-16. Mild pulmonary hypertension is generally in the 25-40 range, moderate is in the 41-55 range, and severe is the >55 range. Remember though that the right ventricular systolic pressure estimate on the echocardiogram gives a peak and not a mean pressure. This means that it gives a highest value rather than an average. 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.
The RVSP and Pulmonary Artery Pressure Estimate from Echo Are Not Perfect
It’s very important to remember that echocardiography is not an exact science and there are many limitations to measurements obtained. Also multiple numbers such as RVSP are being put in to formulas, so any errors will be greater multiplied. 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, 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.
What Are Some Causes of Elevated Right Ventricular Systolic Pressure (RVSP)?
This is split in to primary and secondary causes. Primary pulmonary hypertension is less common than secondary. In primary pulmonary hypertension an underlying cause if often not found for the high pressures in the lungs. In secondary pulmonary hypertension the high pressures are attributed to other causes. 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. Other causes include chronic conditions such as sleep apnea, blood clots in the lungs, lungs disease, lupus, living at altitude, and others. In secondary pulmonary hypertension treatment is typically aimed at the underlying cause. 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.
Questions to Ask Your Physician About Your RVSP
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 the study is suggestive of elevated RVSP and pulmonary hypertension, what is the next step and are any other confirmatory tests required?
If the study is suggestive of elevated RVSP and pulmonary hypertension what is the likely cause and what treatment options are available?
How does the RVSP value obtained on the echocardiogram compare to that found on any previous echocardiograms?