EchoBridgeMD Pearl #6: Don't Underestimate Tricuspid Regurgitation Velocity

An inaccurately aligned Doppler beam can underestimate the tricuspid regurgitation velocity (TRV) and, consequently, the estimated pulmonary artery systolic pressure (PASP).

To maximize accuracy, interrogate the TR jet from multiple acoustic windows—including the right ventricular inflow, parasternal short-axis (aortic valve level), apical 4-chamber, subxiphoid long-axis, and subxiphoid short-axis (aortic valve level) views—and use the view with the most parallel alignment.

Ideally, the continuous-wave Doppler beam should be parallel (0°) to the TR jet, with angles ≤ 20° producing minimal measurement error. Because the modified Bernoulli equation squares the TR velocity, even modest Doppler misalignment can result in clinically significant underestimation of PASP.

Reference:

📖 Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med. 2023.

https://pubmed.ncbi.nlm.nih.gov/37499553/

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