The heart’s function relies on regulated pressures to drive blood flow through the body and lungs. The right side of the heart collects deoxygenated blood and pumps it toward the lungs to pick up oxygen. Right Ventricular Systolic Pressure (RVSP) measures the peak pressure generated by the right ventricle during contraction. This measurement provides insight into how hard the ventricle must contract to move blood forward and is commonly reported during non-invasive heart imaging to evaluate resistance.
What is Right Ventricular Systolic Pressure
Right Ventricular Systolic Pressure (RVSP) is the peak pressure reached inside the right ventricle during systole, the phase when the heart muscle contracts. During systole, the right ventricle ejects blood through the pulmonary valve into the pulmonary artery, leading to the lungs. The pressure generated must be sufficient to overcome the resistance in the pulmonary circulation.
RVSP is typically obtained non-invasively using Doppler echocardiography (heart ultrasound). This technique estimates the pressure by assessing the velocity of blood flow across the tricuspid valve. Most healthy individuals have a minor backward leak, or tricuspid regurgitation (TR), into the right atrium during systole.
The speed of the TR jet relates directly to the pressure difference between the right ventricle and the right atrium. Clinicians use the modified Bernoulli equation, converting the peak velocity (v) of the TR jet into a pressure gradient (4v²), measured in millimeters of mercury (mmHg).
The final RVSP estimate is calculated by adding this pressure gradient to an estimation of the Right Atrial Pressure (RAP). The RAP is often estimated by assessing the diameter and collapsibility of the inferior vena cava (IVC). The complete calculation is RVSP = 4v² + RAP. In the absence of an obstruction, the calculated RVSP is considered equal to the Pulmonary Artery Systolic Pressure (PASP).
Establishing the Normal Range
The normal range for Right Ventricular Systolic Pressure in a healthy, resting adult is generally considered to be below 35 mmHg. The average RVSP in healthy individuals, measured invasively, is closer to 21 mmHg. The 35 mmHg value serves as the upper threshold used in clinical practice to screen for potential pulmonary circulation issues.
This low pressure reflects the low-resistance nature of the pulmonary vascular bed. The right ventricle is designed as a low-pressure pump to move blood to the lungs without excessive force. Values between 35 mmHg and 40 mmHg are often classified as borderline elevated and may warrant further investigation.
The normal value can be influenced by several physiological factors, including age. RVSP tends to remain stable until around age 50, after which it may increase progressively. Transient factors, such as body position, hydration status, and variation during the respiratory cycle, can also affect the measured pressure.
Interpreting Elevated RVSP Readings
When the non-invasive estimate of RVSP consistently rises above 35 mmHg, it signals that the right ventricle is encountering abnormally high resistance. An RVSP reading greater than 40 mmHg suggests elevated pressure within the pulmonary arteries, a condition known as Pulmonary Hypertension (PH). PH is characterized by a high mean pressure in the pulmonary artery.
The right ventricle must work harder to push blood into the stiff or narrowed vessels of the lungs, causing its internal pressure to climb. This increased workload places significant strain on the muscle. The tissue responds to chronic overload by thickening, a process called hypertrophy, in an attempt to generate the necessary force.
Initially, hypertrophy is a compensatory mechanism, but sustained high pressure eventually overwhelms the right ventricle. The chamber can become enlarged and less efficient at pumping, potentially leading to right ventricular failure. An elevated RVSP is a significant finding requiring medical evaluation.
Since echocardiography provides an estimated pressure, an elevated RVSP serves as a screening tool for definitive diagnosis. The gold standard for confirming PH is Right Heart Catheterization (RHC), an invasive procedure. RHC directly measures pressures within the heart chambers and pulmonary artery, which is necessary to classify the severity of the condition and guide treatment decisions.