Haemodynamic Assessment
BSE / ASE reference tables
RAP, PASP & PH probability
IVC diameter and collapse — estimating right atrial pressure
Estimate RAP from subcostal IVC diameter and its inspiratory (sniff) collapse. A dilated, non-collapsing IVC with spontaneous contrast suggests RAP >20 mmHg.
| IVC diameter | Inspiratory collapse | Estimated RAP |
|---|---|---|
| ≤2.1 cm | >50% | 3 mmHg (0–5) |
| ≤2.1 cm | <50% | 8 mmHg (5–10) |
| >2.1 cm | >50% | 8 mmHg (5–10) |
| >2.1 cm | <50% | 15 mmHg (10–20) |
Pulmonary pressures — TR velocity and RVSP severity grading
PASP = 4 × (TR Vmax)² + RAP (no RVOT obstruction). Normal RVSP/PASP ≤34 mmHg.
| Parameter | Normal | Mild | Moderate | Severe |
|---|---|---|---|---|
| TR Vmax (m/s) | <2.8 | 2.8–3.1 | 3.2–3.5 | ≥3.6 |
| RVSP / PASP (mmHg) | ≤34 | 35–49 | 50–69 | ≥70 |
Echo probability of pulmonary hypertension (ESC/ERS)
2022 ESC/ERS echo probability of PH from peak TR velocity plus other PH signs (RV/LV ratio >1, D-shaped septum, RVOT acceleration time <105 ms / mid-systolic notching, PA diameter >25 mm, dilated IVC, RA area >18 cm²).
| Peak TR velocity (m/s) | Other PH signs | PH probability |
|---|---|---|
| ≤2.8 or not measurable | No | Low |
| ≤2.8 or not measurable | Yes (≥2) | Intermediate |
| 2.9–3.4 | No | Intermediate |
| 2.9–3.4 | Yes (≥2) | High |
| >3.4 | Not required | High |
TextbookHumbert et al. 2022 ESC/ERS Guidelines for pulmonary hypertension. Eur Heart J 2022.
Revision flashcards
RAP & pulmonary pressures — flashcards
How is right atrial pressure estimated from the IVC?
| IVC ≤2.1 cm, collapse >50% | 3 (0–5) | mmHg |
| Intermediate pattern | 8 (5–10) | mmHg |
| IVC >2.1 cm, collapse <50% | 15 (10–20) | mmHg |
How is pulmonary artery systolic pressure (PASP) estimated?
| Estimation (no RVOT obstruction) | 4 × (TR Vmax)² + RAP | |
| Normal PASP / RVSP | ≤34 | mmHg |
Echo probability of pulmonary hypertension by TR velocity?
| Peak TR velocity (m/s) | Other PH signs | Probability |
|---|---|---|
| ≤2.8 / not measurable | No | Low |
| ≤2.8 / not measurable | Yes (≥2) | Intermediate |
| 2.9–3.4 | No | Intermediate |
| 2.9–3.4 | Yes (≥2) | High |
| >3.4 | Not required | High |
TextbookHumbert et al. 2022 ESC/ERS Guidelines for pulmonary hypertension. Eur Heart J 2022.