# Right ventricle systolic pressure

## Contents

### Calculation of right ventricle systolic pressure (RVSP)

The right ventricle systolic pressure can be non-invasively measured by echocardiography.

It is obtained by the addition of the pressure gradient between the right ventricle and the right atrium, to the pressure in the right atrium.

#### Measurement of the pressure gradient between right ventricle (RV) and right atrium (RA)

The RV-RA pressure gradient is measured using the maximum velocity of the tricuspid regurgitation jet.

The maximum velocity measured as the peak regurgitation (systolic) is converted to pressure with Bernouilli law:

P = 4 V2

The maximum velocity of the tricuspid regurgitation can be measured from the parasternal short axis view or from the apical 4 chamber view. It is crucial to get a good envelope of the regurgitant jet, which means that the measurement is accurate.

#### Estimation of right atrium (RA) pressure

In patients with central venous lines, the RA pressure is easily measured: it is the central venous pressure (CVP).

In spontaneously breathing patients, the RA pressure is estimated from the measurement of the IVC size and collapsibility index:

(maximum diameter - minimum diameter) / maximum diameter.

### Example

Apical 4 chamber view, color Doppler on tricuspid valve. Visualization of trace tricuspid regurgitation

Apical 4 chamber view, CW-Doppler aligned on tricuspid regurgitation. Measurement of maximum velocity: 228 cm/sec, translated into maximum pressure gradient between RV and RA: 21mmHg.

Subcostal view, Mmode on IVC. Measurement of maximum and minimum diameter.

-->  Collapsibility index = (25.4-23.7)/25.4 = 7 %

-->  RA pressure estimated at 20mmHg

Result: RVSP = 21 + 20 = 41 mmHg

### Reference

Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Moreno F.L., Hagan A.D., Holmen J.R., Pryor T.A., Strickland R.D., Castle C.H. Am J Cardiol (1984) 53 : pp 579-585