TR peak velocity signal selection
Read more:ASE 2025 · Right heart and pulmonary hypertensionASE 2019 · Comprehensive TTE examinationASE 2026 · Cardiac ultrasound artifacts
Quick reference:↑ RAP, pulmonary pressures and RV–PA coupling
| View | CW Doppler of the TR jet from multiple windows (apical, parasternal RV inflow, subcostal), colour-guided to align with the jet. |
|---|---|
| Timing | Peak of the dense systolic envelope; in AF average 5–10 cycles rather than the single highest beat. |
| Caliper / trace | Peak velocity at the modal (densest) margin of the highest-quality, highest-velocity signal; poor-quality signals are edited out, not reported. |
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Correct example
Several sites interrogated, the complete dense envelope with the highest velocity selected, no overgain, and an incomplete envelope reported as inadequate rather than as a low velocity.
Common error
Tracing a faint, incomplete envelope beyond the modal signal, taking the highest single beat in AF, or measuring with ultrasound enhancing agent transit signals that inflate the peak.
Effect on interpretation
RVSP = 4·V² + RAP, so velocity errors are squared; an inadequate TR envelope does not mean normal pressure, and RVSP equals PASP only without RVOT or pulmonic obstruction.
Why
Peak TR velocity reflects the RV–RA systolic gradient; alignment and envelope completeness decide whether the Bernoulli estimate is valid, which is why weak or marginal signals are withheld.