RVSP in Tricuspid Regurgitation: Useful Marker or Misleading Metric?

Tricuspid regurgitation (TR) is one of the most frequently encountered findings on transthoracic echocardiography (TTE), yet it is also one of the most commonly misinterpreted. Beyond a simple color Doppler jet, TR reflects the pressure relationship between the right ventricle and right atrium, making it a critical window into right heart hemodynamics.

This lesson focuses on how to accurately assess tricuspid regurgitation and correctly estimate right ventricular systolic pressure (RVSP) using Doppler echocardiography. You’ll learn how TR severity, right atrial pressure, and Doppler signal interpretation directly influence pulmonary pressure estimation and clinical decision-making.

You’ll learn how to:

• Differentiate primary vs secondary tricuspid regurgitation

• Estimate right atrial pressure using IVC size and collapsibility

• Apply the Bernoulli equation to calculate RVSP

• Understand the relationship between RVSP and PASP

• Recognize why CW Doppler waveform shape (U-shaped vs V-shaped) matters—especially in severe TR

Aligned with the American Society of Echocardiography right heart and pulmonary hypertension guidelines, this practical review sharpens how you evaluate one of the most important—and nuanced—valvular findings in daily echocardiography practice.