PH Echo Estimator Experimental

RV systolic pressure from the TR jet

RV-RA gradient [mmHg] = 4 x V^2          V = peak TR velocity in m/s (simplified Bernoulli)
RVSP [mmHg]           = 4 x V^2 + RA pressure
RVSP / systolic BP    = shown as a fraction of systemic pressure (no category assigned)

Yock & Popp 1984: TR jets were recordable in 54 of 62 patients with clinically elevated right-sided pressures; 4V² plus mean RA pressure (estimated clinically from the jugular veins) correlated with catheter RVSP, r = 0.93, SEE 8 mmHg. RVSP equals PA systolic pressure only without RV outflow or pulmonary valve obstruction. Burkett 2020 reported TR not measurable in 21.8% of pediatric PH studies; Levy 2016 notes clinically relevant discrepancies between Doppler and catheter pressures in children.

PA acceleration time (Levy 2016)

sPAP [mmHg]      = 64 - 0.39 x PAAT [ms]
mPAP [mmHg]      = 48 - 0.28 x PAAT
PVR  [WU]        = 12 - 0.10 x PAAT
PVRi [WU x m2]   =  9 - 0.07 x PAAT
Cut-offs for PH (PVRi >3 WU.m2 and mPAP >25 mmHg): PAAT <90 ms (sens 97%, spec 95%); PAAT/RVET <0.31 (sens 87%, spec 89%)
PAAT <40 ms: regressions unpredictable; detected PVRi >10, mPAP >45, sPAP >65 (sens 93%, spec 92%)

• Derivation: 75 children aged 1–18 years (median 5.3) with wide-ranging hemodynamics at Saint Louis Children’s; validation: 50 children. Excluded: single ventricle, mechanical tricuspid valve, RV outflow obstruction, left heart disease, arrhythmias, pulmonary insufficiency, pulmonary vasodilators. Validated at heart rates 55–150 bpm. Overall cohort ranges: mPAP 12–60 mmHg, PVR 2–10.4 WU, PVRi 2–18 WU·m²; estimates below these ranges are flagged as extrapolation and zero or negative estimates are not shown. Equations from the PMC author manuscript (PMC5408579).
• Not validated in infants under 1 year, including preterm infants; this page withholds the estimates there.
• Age-specific normal values and z-scores for PAAT in children: Koestenberger 2017 (756 healthy children; neonates median 81 ms, range 53–104; 18th year median 151 ms, range 107–187; z <−2 predictive of PH). The z-score equations were not retrieved, so no PAAT z-score is computed [unverified].

LV eccentricity index

EI = LV minor-axis diameter parallel to the septum / diameter perpendicular to (bisecting) the septum

• Ryan 1985: normal EI essentially 1.0 at end-systole and end-diastole; RV pressure overload raised end-systolic EI (1.44 ± 0.16 in adults with PA systolic >40 mmHg).
• Burkett 2020 (78 pediatric PH patients with simultaneous cath, 78 controls; diameters from compact myocardium): control end-systolic EI 0.99 [0.97–1.04]; end-systolic EI 1.16 best identified PH (mPAP >25 mmHg, AUC 0.807); maximal EI 1.42 and 1.94 best identified half-systemic and systemic PH. The authors state these values “must be validated before clinical use”.
• Abraham & Weismann 2016 (216 NICU infants, reference = qualitative assessment): septal flattening recognized at EIs ≥1.15; more than half-systemic RV pressure apparent at EIs ≥1.3.
• Averin 2016 (29 children, 46 studies, echo within 30 days of cath): LVEI >1.24 (sens 88%, spec 83%) and >1.48 (sens 76%, spec 100%) for RV/aortic systolic pressure >0.5.
• Simpkin 2026: after complete AVSD repair EI is higher than in healthy children even without PAH; end-systolic EI >1.28 best predicted elevated RVSP and PVRi.

TAPSE

• Koestenberger 2009 (640 healthy children, 1 day to 18 years): TAPSE rises with age and BSA, from a mean of 0.91 cm (±3 z: 0.56–1.26 cm) in neonates to 2.47 cm (1.84–3.10 cm) at 18 years, with no sex difference (abstract, verified). The full age-group table is in the paper and was not retrieved, so this page accepts a z-score you obtain elsewhere and flags z <−2 only.
• Reduced TAPSE is listed among echocardiographic determinants of higher risk in pediatric PAH (WSPH 2019 Paediatric Task Force); it is not turned into a score here.

What this page does not do

It does not combine markers into a points score: no validated pediatric PH echo score exists. Each marker is reported against the cut-off of the study that derived it, with that study’s population.

References

• Abman SH, Hansmann G, Archer SL, et al. Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society. Circulation 2015;132(21):2037-2099. doi:10.1161/CIR.0000000000000329
• Rosenzweig EB, Abman SH, Adatia I, et al. Paediatric pulmonary arterial hypertension: updates on definition, classification, diagnostics and management. Eur Respir J 2019;53(1):1801916. doi:10.1183/13993003.01916-2018
• Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984;70(4):657-662. doi:10.1161/01.cir.70.4.657
• Levy PT, Patel MD, Groh G, et al. Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children. J Am Soc Echocardiogr 2016;29(11):1056-1065. doi:10.1016/j.echo.2016.08.013
• Koestenberger M, Grangl G, Avian A, et al. Normal Reference Values and z Scores of the Pulmonary Artery Acceleration Time in Children and Its Importance for the Assessment of Pulmonary Hypertension. Circ Cardiovasc Imaging 2017;10(1):e005336. doi:10.1161/CIRCIMAGING.116.005336
• Ryan T, Petrovic O, Dillon JC, et al. An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 1985;5(4):918-927. doi:10.1016/s0735-1097(85)80433-2
• Burkett DA, Patel SS, Mertens L, Friedberg MK, Ivy DD. Relationship Between Left Ventricular Geometry and Invasive Hemodynamics in Pediatric Pulmonary Hypertension. Circ Cardiovasc Imaging 2020;13(5):e009825. doi:10.1161/CIRCIMAGING.119.009825
• Abraham S, Weismann CG. Left Ventricular End-Systolic Eccentricity Index for Assessment of Pulmonary Hypertension in Infants. Echocardiography 2016;33(6):910-915. doi:10.1111/echo.13171
• Averin K, Michelfelder E, Sticka J, Cash M, Hirsch R. Changes in Ventricular Geometry Predict Severity of Right Ventricular Hypertension. Pediatr Cardiol 2016;37(3):575-581. doi:10.1007/s00246-015-1317-z
• Simpkin CT, DeLima M, MacBeth M, et al. Eccentricity Index Is Associated With Pulmonary Arterial Hypertension in Children After Repair of Complete Atrioventricular Septal Defects. Echocardiography 2026;43(4):e70451. doi:10.1111/echo.70451
• Koestenberger M, Ravekes W, Everett AD, et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 2009;22(6):715-719. doi:10.1016/j.echo.2009.03.026