Right ventricular systolic pressure
Right ventricular systolic pressure (RVSP) can be easily assessed in most subjects who present some degree of tricuspid regurgitation. The velocity recorded across the regurgitant jet corresponds to the right ventricular-right atrial gradient (RV-RA ΔP), so that, this value added to mean right atrial pressure (RAP) represents the right ventricular systolic pressure:
RVSP = RV-RA ΔP + RAP
Right atrial pressure
The right atrial pressure (RAP) can be estimated from the end-expiratory diameter and respiratory changes of the inferior vena cava (IVC) as follows:
- Normal diameter (≤2,1 cm) and inspiratory collapse (>50%), RAP 3 mmHg (range, 0-5 mmHg)
- Dilated IVC (≥ 2,1 cm) with reduced respiratory variation (<50%), RAP 15 mmHg (range, 10-20 mmHg)
- IVC diameter and respiratory variation unfitting the previous paradigm, without resolving hepatic flow pattern (absence of prevalent systolic or diastolic flow component) or tricuspid E/e’ wave ratio, RAP 8 mmHg (range, 5-10 mmHg)
Pulmonary artery systolic pressure
If there is no obstruction at the right ventricular outflow tract, RVSP equals the pulmonary artery systolic pressure
Pulmonary artery diastolic pressure
Pulmonary artery end-diastolic pressure (PADP) can be estimated in the presence of a well-distinct pulmonary regurgitation flow as follows:
PADP = EDP ΔP + RAP
Mean pulmonary artery pressure
Mean pulmonary artery pressure (MPAP) can be easily derived by systolic and diastolic pressure as:
1/3 PASP + 2/3 PADP.
Left ventricular filling pressure
Left ventricular filling pressure and so atrial diastolic pressure can be estimated using a combination of Doppler parameters. Although mitral inflow Doppler pattern alone allows a first classification of diastolic dysfunction, especially in subjects with reduced systolic function, its dependence on load condition and other factors (i.e. age and heart rate), requires its integration with tissue-Doppler (TD) imaging assessment of left ventricular myocardial velocities, pulmonary venous flow.
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