Table 1.

Stanford workup algorithm for patients with borderline elevation in right ventricular systolic pressure (RVSP) on echocardiogram (Echo). PH = pulmonary hypertension, RV = right ventricle, LV = left ventricle, EF = ejection fraction, WHO = world health organization, COPD = chronic obstructive pulmonary disease, ILD = interstitial lung disease, OSA = obstructive sleep apnea, FVC = forced vital capacity, DLCO = diffusing capacity for carbon monoxide.

RVSP	RV size and/or function	Sympto ms	Risk Factors	Recommended Action
RVSP 35-45 mmHg	Abnormal	N/A	N/A	Full workup
	Normal	No symptoms	Any PH risk factors	Repeat echo q6-12 months
			No PH risk factors	Repeat echo in 12 months If echo is stable and the patient has no symptoms, discharge from clinic
		(+) Symptoms	Any WHO Group 1 risk factors	Full workup
			Diastolic dysfunction	Optimize BP and volume status and recheck echo If optimized, consider full workup
			Valvular heart disease	If MR / AR is > moderate-severe, refer to cardiology & hemodynamics testing, optimize volume status then recheck echo. If optimized, consider full workup
			LV systolic dysfunction	If EF < 35%, no further workup. Refer to cardiology
			COPD	Consider Full workup
			ILD	If FVC/DLCO > 1.6, consider full workup
			OSA	Optimize OSA treatment and repeat echo. If optimized, consider full workup
			Altitude > 3,000 ft	Consider Full workup
			Thromboembolic disease	Full workup
			Any WHO Group 5 risk factors	Consider full workup