From the Guidelines
The patient does not require right heart catheterization unless they have a specific clinical indication, such as presumed cardiogenic shock, severe clinical decompensation, or persistent severe symptoms despite adjustment of recommended therapies, as stated in the 2013 ACCF/AHA guideline for the management of heart failure 1.
Indications for Right Heart Catheterization
The decision to perform a right heart catheterization should be based on specific clinical indications, including:
- Presumed cardiogenic shock requiring escalating pressor therapy and consideration of mechanical circulatory support (MCS) 1
- Severe clinical decompensation in which therapy is limited by uncertain contributions of elevated filling pressures, hypoperfusion, and vascular tone 1
- Apparent dependence on intravenous inotropic infusions after initial clinical improvement 1
- Persistent severe symptoms despite adjustment of recommended therapies 1
Contraintications for Routine Use
Routine use of invasive hemodynamic monitoring is not recommended in normotensive patients with acute decompensated heart failure who have a symptomatic response to diuretics and vasodilators, as stated in the 2013 ACCF/AHA guideline for the management of heart failure 1.
Additional Considerations
The American College of Radiology (ACR) Appropriateness Criteria for suspected pulmonary hypertension also support the use of right heart catheterization in specific clinical scenarios, such as when echocardiography and catheterization are complementary examinations, and both should be performed 1.
Clinical Decision-Making
To determine if a patient requires a right heart catheterization, a cardiologist should carefully consider the potential benefits versus risks of this invasive procedure for the individual patient, taking into account specific clinical information, including symptoms, physical examination findings, results of non-invasive testing, and the patient's medical history.
From the Research
Indications for Right Heart Catheterization (RHC)
- RHC is a minimally invasive method for obtaining hemodynamic data, which is essential for diagnosing and managing patients with advanced heart failure (HF), HF with preserved ejection fraction, and pulmonary hypertension (PH) 2, 3, 4.
- The procedure is used to assess invasive hemodynamics, guide decisions for implanting mechanical circulatory support devices, and list patients for heart and/or lung transplantation 2, 3.
- RHC is also useful for stratification roles and serves therapeutic purposes in patients with chronic congestive heart failure 3.
Clinical Applications of RHC
- RHC is a cornerstone diagnostic tool for patients in refractory heart failure or cardiogenic shock, as well as for assessing candidacy for heart replacement therapies 3.
- The procedure provides valuable information for the management of advanced therapies in heart failure (HF) and cardiogenic shock (CS) 4.
- RHC is used to measure right atrial, right ventricular, and pulmonary artery pressures, estimate cardiac output, identify intracardiac shunts, and measure pulmonary vascular resistance 5.
Importance of RHC in Clinical Practice
- RHC plays a central role in identifying pulmonary hypertension (PH) disorders and is required to definitively diagnose pulmonary arterial hypertension (PAH) 6.
- The procedure is essential for monitoring treatment response and establishing prognosis in patients diagnosed with PAH 6.
- However, standardization of RHC procedures is necessary to ensure optimal use in routine clinical practice and to prevent errors in measurement and data interpretation 6.