Echocardiographic PH Probability (TTE-based) Calculator
- Echocardiographic PH Probability Algorithm (TTE-based): Explanation and Clinical Context
This calculator applies the 2022 ESC/ERS transthoracic echocardiographic algorithm for pulmonary hypertension (PH). It integrates the peak tricuspid regurgitation velocity (TRV) with secondary echocardiographic signs grouped into three categories (A, B, and C). A TRV > 3.4 m/s alone indicates a high probability of PH. When TRV is 2.9–3.4 m/s, additional findings from ≥ 2 categories raise the probability to high; otherwise it remains intermediate. If TRV ≤ 2.8 m/s or unmeasurable, PH probability is intermediate only if ≥ 2 additional signs are present.
Category A (Ventricles) includes RV/LV basal area ratio > 1.0, septal flattening (LVEI > 1.1), and TAPSE/sPAP < 0.55. Category B (Pulmonary artery) includes short RVOT acceleration time (< 105 ms) or mid-systolic notch, early diastolic PR ≥ 2.2 m/s, and PA diameter > 25 mm. Category C (IVC/RA) includes IVC ≥ 21 mm with reduced collapse and RA area > 18 cm². When signs from ≥ 2 categories are present, TRV-based probability shifts upward.
This algorithm improves diagnostic precision for suspected PH and guides the need for right heart catheterization, particularly in the presence of PAH or CTEPH risk factors.
References:
Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618–3731. doi:10.1093/eurheartj/ehac237.
D’Alto M, Romeo E, Argiento P, et al. Echocardiographic probability of pulmonary hypertension: a validation study. Eur Respir J. 2022;60(2):2102548. doi:10.1183/13993003.02548-2021.
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