Diagnostic Accuracy of Echocardiographic Right Ventricular Systolic Pressure and Tricuspid Regurgitation Velocity in Estimating Elevated Pulmonary Pressures: A Multicenter Retrospective Cohort Study

Background Echocardiography is widely used to screen for pulmonary hypertension and guide referral for right heart catheterization (RHC). Right ventricular systolic pressure (RVSP) estimates pulmonary arterial systolic pressure (PASP), yet their agreement in a large real-world cohort remains uncertain. Question How well do echocardiographic right ventricular systolic pressure (RVSP) and tricuspid regurgitation (TR) jet velocity correlate with invasive pulmonary hemodynamics, and how do they compare in detecting elevated mean pulmonary arterial pressure (mPAP)? Study Design and Methods Retrospective, multicenter cohort study of 14,084 adult patients undergoing RHC and echocardiography at two academic hospitals in Boston, Massachusetts. Diagnostic comparison was performed on a subset of 7,652 patients in which both RVSP and TR jet were available. Correlation and calibration were assessed using Spearman correlation, linear regression, and Bland–Altman analyses. Diagnostic performance for mPAP >20 mmHg and ≥35 mmHg was evaluated using sensitivity, specificity, predictive values, and area under the curve (AUC). Results Mean (SD) age was 66.6 (14.7) years. RVSP and PASP were moderately correlated (ρ=0.59; P<.001). Regression showed dynamic range compression (slope 0.63; intercept 16.6 mmHg), reflecting overestimation at lower and underestimation at higher PASP. Mean bias was minimal (0.08 mmHg), but limits of agreement were wide (±30 mmHg). For mPAP >20 mmHg, RVSP ≥35 mmHg was more sensitive than TR velocity ≥2.8 m/s (72% vs 61%) but less specific (66% vs 78%). For mPAP ≥35 mmHg, RVSP ≥50 mmHg and TR velocity ≥3.2 m/s performed similarly (AUC 0.76 vs 0.75). Interpretation RVSP showed moderate correlation but calibration error and limited precision relative to invasive PASP. Although RVSP and TR velocity demonstrated fair discrimination for elevated mPAP, RHC remains essential for definitive diagnosis.