Echo probability of PH is determined by the peak tricuspid regurgitation velocity (TRV) combined with additional supporting signs. This replaces the older RVSP-only approach.
TRV ≤2.8 m/s
No additional signs
PH unlikely. Consider alternative diagnosis.
TRV ≤2.8 m/s + signs, OR TRV 2.9–3.4 m/s ± signs
≥1 additional echo sign
Consider further evaluation. Right heart catheterization may be needed.
TRV >3.4 m/s
Any additional signs
Refer for right heart catheterization to confirm PH.
At least 2 signs from different categories strengthen the probability
| Parameter | Normal | Abnormal | Clinical Note |
|---|---|---|---|
| TRV (peak) | ≤2.8 m/s | >2.8 m/s | >3.4 m/s = high PH probability |
| RVSP (estimated) | <35 mmHg | ≥35 mmHg | RVSP = 4×TRV² + RAP; not used alone for PH diagnosis |
| RV/LV basal ratio | <1.0 | ≥1.0 | RV enlargement sign |
| TAPSE | ≥17 mm | <17 mm | RV longitudinal dysfunction |
| RV S' (TDI) | ≥9.5 cm/s | <9.5 cm/s | Lateral tricuspid annulus |
| RV FAC | ≥35% | <35% | RV systolic dysfunction |
| PAAT | ≥105 ms | <105 ms | <60 ms with notching = severe PH |
| PA diameter | ≤25 mm | >25 mm | Measure at PSAX, end-diastole |
| RA area | ≤18 cm² | >18 cm² | Measured end-systole |
| IVC diameter | ≤21 mm | >21 mm | Measured 1–2 cm from RA junction |
| IVC collapse (sniff) | >50% | ≤50% | ≤50% + IVC >21 mm = RAP 15 mmHg |
| RIMP (Tei index) | <0.40 (PW), <0.55 (TDI) | ≥0.40 / ≥0.55 | Global RV dysfunction marker |
Pulmonary Hypertension Echo Assessment Checklist
0/16