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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...

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Comprehensive Echocardiographic Assessment of Right Ventricle Function in a Rat Model of Pulmonary Arterial Hypertension
07:38

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Reporting changes in right ventricular systolic pressure: insights from Classification and Regression Tree (CART)

Shadi P Bagherzadeh1,2, Kartik S Malunjkar3, Neha M Mantri3,4

  • 1Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA. shadi.bagherzadeh@mountsinai.org.

Echo Research and Practice
|June 7, 2026
PubMed
Summary

Physicians often consider an 8 mmHg change in right ventricular systolic pressure (RVSP) significant for pulmonary hypertension (PH) monitoring. Analytical variability suggests a 15% reference change value is needed for meaningful RVSP interpretation.

Keywords:
Analytical variabilityCART analysisPulmonary hypertensionReference changeRight ventricular systolic pressure

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Pulmonary Hypertension Research

Background:

  • Right ventricular systolic pressure (RVSP) is a key echocardiographic marker for monitoring pulmonary hypertension (PH).
  • Current guidelines lack defined thresholds for clinically significant RVSP changes.
  • Understanding physician reporting practices and analytical variability is crucial for accurate PH management.

Purpose of the Study:

  • To investigate how physicians report significant changes in RVSP.
  • To quantify the analytical variability in RVSP measurements.
  • To inform future recommendations for reporting RVSP changes in PH.

Main Methods:

  • Utilized a large registry (5,934 patients, 32,656 echocardiograms) with Natural Language Processing and Classification and Regression Tree (CART) analysis.
  • Assessed reporting thresholds based on absolute change (8 mmHg) and reference range status.
  • Employed duplicate analysis on a separate cohort (210 healthy, 208 PH patients) to model bias and analytical variability.

Main Results:

  • Physicians commonly use an 8 mmHg absolute threshold for RVSP change, considering its relation to the reference range.
  • CART model achieved high accuracy (81-83%) and F1-scores (74-79%) for detecting RVSP increase/decrease.
  • Analytical precision was 8-10%, leading to a 15% reference change value, particularly at lower RVSP values.

Conclusions:

  • Physician reporting of RVSP changes in real-world practice often relies on an 8 mmHg threshold.
  • Analytical variability necessitates a 15% reference change value for robust RVSP interpretation.
  • Findings provide a basis for developing standardized recommendations for reporting RVSP changes in PH.