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.
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How is RVSP Measured?
A right heart catheterization.
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
Tricuspid regurgitation (TR) on echocardiogram. RV is right ventrical and RA is right atrium.
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
If your echo report says you have elevated RVSP or evidence to suggest pulmonary hypertension, the following questions may be useful to ask.
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?
Comments are purely for informational purposes and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Disclaimer
Hello i had an echo today I’m 4 months postpartum and everything on my echo was normal. My pulmonary pressure was between 33-36. It stated mild pulmomary hypertension would this be considered normal since i recently delivered or do i have pulmonary hypertension
I would recommend asking the Dr who read the echo, it needs to be ensured the pattern of the wave form is accurate and interpreted correctly as opposed to a machine read out. 33-36 is certainly not in a moderate or severe range.
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I had an echo done at my cardiologist and my rvsp was 40 rest of the echo normal. I went to a pulmonary hypertension specialist and now my rvsp is 36. I am morbidly obese. I have lost 17 pounds since my first Echo. Could the weight loss have lowered my pulmonary pressures?
he also said i had mild grade on left diastolic dysfunction. can i live a normal life span with this? i am 54.
Hi. I am a 38 year old female trying to figure out if my shortness of breath while doing nothing and also shortness of breath and racing heart once I reach the top of the stairs is due to PH or is it due to health anxiety. In 2013 I saw pulmonary doc…he did workup and said everything good…however I noticed the xray reader noted “mild prominent pulmonary artery which could indicate pulmonary hypertension”. Doctor didnt seemed worried. 2 month later I saw a cardiologist and did stress test which was fine and the echo is below. It states mild pulmonary hypertension. Pasp of 30 …rvsp of 29.9. But he is not concerned. Why? I also have lots of bloating and have had an ent tell me i show signs of reflux when he looked down throat with camera. He says it may be silent relfux causing breathing problems. Please give me your opinion….am I panicking for nothing? I havent had an echo in 4 years…had a stress echo last year though and they said was fine…didnt say anything about pressures or nothing.
SUMMARY:
Left ventricle: Systolic function was normal. Ejection fraction was
estimated in the range of 60 % to 65 %. There were no regional wall motion
abnormalities.
Mitral valve: There was a mild prolapse. There was mild regurgitation.
Tricuspid valve: There was mild regurgitation. There was mild pulmonary
hypertension.
INDICATIONS: Patient’s heart rate drop from 58 bpm to 45 bpm. This
information was brought to the doctor’s attention. Patient was assess by
the nurse practitioner before leaving the office. Patient’s heart rate is
60 bpm before leaving the office. She has appointment schedule. Shortness
of breath. Palpitations. Mitral valve disorders.
PROCEDURE: This was a routine study. The study included complete 2D
imaging, M-mode, complete spectral Doppler, and color Doppler. The heart
rate was 45 bpm, at the start of the study. Systolic blood pressure was
120 mmHg, at the start of the study. Diastolic blood pressure was 70 mmHg,
at the start of the study. Images were obtained from the parasternal,
apical, subcostal, and suprasternal notch acoustic windows. Image quality
was adequate.
LEFT VENTRICLE: Size was normal. Systolic function was normal. Ejection
fraction was estimated in the range of 60 % to 65 %. There were no
regional wall motion abnormalities. Wall thickness was normal. DOPPLER:
The transmitral flow pattern was normal. The deceleration time of the
early transmitral flow velocity was normal. The pulmonary vein flow
pattern was normal. Left ventricular diastolic function parameters were
normal.
RIGHT VENTRICLE: The size was normal. Systolic function was normal. Wall
thickness was normal.
LEFT ATRIUM: Size was normal.
RIGHT ATRIUM: Size was normal.
MITRAL VALVE: There was mild thickening. There was a mild prolapse.
DOPPLER: The transmitral velocity was within the normal range. There was
mild regurgitation.
AORTIC VALVE: The valve was trileaflet. Leaflets exhibited normal
thickness and normal cuspal separation. DOPPLER: Transaortic velocity was
within the normal range. There was no stenosis. There was no regurgitation.
TRICUSPID VALVE: Normal valve structure. There was normal leaflet
separation. DOPPLER: The transtricuspid velocity was within the normal
range. There was no evidence for tricuspid stenosis. There was mild
regurgitation. Pulmonary artery systolic pressure: 30 mmHg. There was mild
pulmonary hypertension.
PULMONIC VALVE: Leaflets exhibited normal thickness, no calcification, and
normal cuspal separation. DOPPLER: The transpulmonic velocity was within
the normal range. There was no regurgitation.
AORTA: The root exhibited normal size.
PERICARDIUM: There was no pericardial effusion. The pericardium was normal
in appearance.
SYSTEM MEASUREMENT TABLES
2D
Ao Diam: 3.2 cm
LAESV Index (A-L): 25.4 ml/m2
IVSd: 1 cm
LVIDd: 4.2 cm
LVPwd: 1.1 cm
CW
RAP: 10 mmHg
TR Vmax: 2.2 m/s
TR maxPG: 19.9 mmHg
PW
RVSP: 29.9 mmHg
With regard to your cardiac testing including you echocardiogram it appears to be relatively normal and I do not see any cause for alarm here unless you have been told differently by a treating physician. Also the right ventricular systolic pressure you have reported is essentially in a normal range.
you can follow my twitter at @MustafaAhmedMD
Please interpret my Echo Report Normal LV with normal systolic function No segmental wall motion abnormality seen Normal Mitral and Aortic vavle Normal sized RV. No PS Normal Pulmonaric and Tricuspid valve No pericardial effession seen No LV clot seen No Vegetation seen RVOT= 14 mmHg Normal Diastolic function E = 1.11 m/s: E/A=1.35 E/E= 13 A=0.82 m/s: DCT = 73 m/s IVRT = 53 m/s (74+-7) Estimated RV/MPAP = 30mmHg EF= 60% TR Mild with Mild PAH During the test patient has Fast HR (Other all values are in normal range) except TAPSE = 28mm S wave = 14 cm/s * Fast HR was from my anxiety. Because I’m too anxious and suffering from anxiety disorder from past 5 months. And at the time of echo my B.P was a little high 140/90. The question is this, that i really have PAH or it is just misdignosed due to fast HR which put pressure on this? I don’t have any symptoms except a short episode of PVC and little fast HR for a short period. my resting HR is 50 – 65 BPM. I’ll be very thankful for your kind replay. Thank you so much.
Its likely normal. The finding needs to be discussed with the ordering provider and the scan reviewed to determine the true accuracy of the reading.
you can follow my twitter at @MustafaAhmedMD
I did chest pain, blood test they are normal
Please comments on my Echo Report
Normal LV with normal systolic function
No segmental wall motion abnormality seen Normal Mitral and Aortic vavle
Normal sized RV. No PS
Normal Pulmonaric and Tricuspid valve
No pericardial effession seen
No LV clot seen
No Vegetation seen
RVOT= 14 mmHg
Normal Diastolic function
E = 1.11 m/s: E/A=1.35 E/E= 13
A=0.82 m/s: DCT = 73 m/s
IVRT = 53 m/s (74+-7)
Estimated RV/MPAP = 30mmHg
EF= 60-65%
TR Mild with Mild PAH
(Other all values are in normal range) except TAPSE = 28mm S wave = 14 cm/s
* Note: During the test patient has Fast HR
☆(Fast HR was from my anxiety. Because I’m too anxious and suffering from anxiety disorder from past 5 months. The question is this, that i really have PAH or it is just misdignosed due to fast HR which put pressure on this? At the time of echo my B/P was also little high 140/90.
I don’t have any symptoms except a short episode of PVC and little fast HR for a short period. my resting HR is 50 – 65 BPM.
I’ll be very thankful for your kind replay. Thank you so much.
One lung destroyed. Rvsp is51 using sildinafil 100 mg per day.is it serious?
Yes it is serious, needs close follow up and treatment and input from lung specialists and pulmonary hypertension specialists.
you can follow my twitter at @MustafaAhmedMD
Hello Dr Ahmed i had mild pulmonary hypertension and it seems it went away.Is this possible or can it come back?
Hi Dr Ahmed,
I’m a 37 year old female who for the past 3 weeks has experienced a sudden onset of chest pain/tightness, shortness of breath and fatigue. My ekg and chest x-ray were normal. My echo showed mild tricuspid regurgitation as well as right ventricle peak pressure of at least 31 mmHG. My cardiologist suspected pericarditis however this was not confirmed by the echo or sed rate. He has now ordered a stress echo. Is pulmonary hypertension a possibility? I seem to experience the shortness of breath and fatigue after even small amounts of exertion. Last month I had the flu which then led into pneumonia. I thought I recovered and symptoms started 2 weeks after ending my steroid and antibiotic.
Without looking at the echo its difficult to know the accuracy of the value. However if the pressure is only 31, this is unlikely to represent clinically significant pulmonary hypertension.
you can follow my twitter at @MustafaAhmedMD
MVP 65 year old female
Echnormal left ventricular systolic function and size
Estimated left ventricular ejection fraction is 55%
Moderate tricuspid regurgitation
Moderate mitral regurgitation
Estimated pulmonary artery systolic pressure is 49mmHg
Taking Atenolol 12.5 mg once a day
No other medications
Lightheadedness and fatigue
Should I be concerned? See Dr back in one year. No swelling in ankles. My weight is 135 lbs. Should ask be a n diuretic?
Not necessarily concerned, however its important to be followed and ensure the issues remain stable.
you can follow my twitter at @MustafaAhmedMD
Hello Dr. Mustafa Ahmed,
My Mother is having ALCAPPA, we got to know about this 6 years back and her treatment was on medicine only. Recently during her regular cardiac check-up we have gone through with 2D ECHO
here is a report of ECHO
IMPRESSION :
ALCAPPA
PRESERVED LV SYSTOLIC FUNCTION, LVEF = 55%
SEVERE MITRAL REGURGITATION, GRADE IV/IV
SEVERE PULMONARY HYPERTENSION(RVSP = 80 MMHg.
Doctor suggested for Heart Transplant, but we ( Family) is looking for 2nd opinion, as we are not comfortable to go with such a big surgery . Please Suggest.