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.