From the Guidelines
Heart catheterization is indicated for patients with suspected or known coronary artery disease, valvular heart disease, congenital heart defects, heart failure, or cardiomyopathy when non-invasive testing is inconclusive or additional information is needed for diagnosis and treatment planning.
Indications for Heart Catheterization
The following are specific indications for heart catheterization:
- Evaluation of chest pain or angina with abnormal stress test results
- Assessment of coronary anatomy before cardiac surgery
- Evaluation of unexplained heart failure
- Assessment of valvular function and hemodynamics
- Diagnosis of congenital heart defects
- Monitoring of cardiac function in critically ill patients
- Therapeutic interventions such as coronary angioplasty and stent placement, valve repair or replacement, closure of septal defects, and ablation of arrhythmias
Diagnostic Capabilities
Heart catheterization provides direct visualization of coronary arteries, measurement of pressures within heart chambers, assessment of cardiac output, and evaluation of oxygen saturation in different heart chambers 1. This information is crucial for diagnosing and managing various cardiac conditions, including coronary artery disease, valvular heart disease, and congenital heart defects.
Risks and Benefits
While heart catheterization is a valuable diagnostic and therapeutic tool, it carries risks including bleeding, infection, arrhythmias, stroke, heart attack, and contrast-induced nephropathy 2, 3. Therefore, the procedure is typically reserved for situations where the diagnostic or therapeutic benefits outweigh these potential risks.
Current Guidelines
According to the 2018 AHA/ACC guideline for the management of adults with congenital heart disease, cardiac catheterization remains a standard tool for diagnosis, prognosis, or management when more precise definition of anatomy is required, or when calculation of pressures and resistances is necessary 1. Additionally, the 2017 ACR Appropriateness Criteria for known or suspected congenital heart disease in adults suggest that cardiac catheterization is primarily used to resolve specific issues related to surgical intervention or as an adjunct to noninvasive assessment of morphologic and functional characteristics of complex CHD 3.
From the Research
Indications for Heart Catheterization
The indications for heart catheterization can be summarized as follows:
- Diagnostic catheterization is appropriate for patients with suspected coronary artery disease, especially those with symptoms or high-risk findings on stress tests 4, 5, 6.
- Right heart catheterization can provide important information on hemodynamic variables, such as pulmonary hypertension and cardiac index, which can influence patient management 5.
- Coronary angiography is indicated for patients with suspected stable ischemic heart disease, and the appropriate use criteria can help guide clinical decision making 6.
- Catheterization can be used to diagnose and treat coronary artery disease, and exercise-based rehabilitation is recommended for all patients with coronary artery disease 7.
- In patients with out-of-hospital cardiac arrest, coronary artery disease is prevalent, and early access to the cardiac catheterization laboratory is associated with improved survival rates 8.
Patient Characteristics and Appropriateness Ratings
The relationships between patient characteristics and appropriateness ratings for diagnostic catheterization are:
- Patients with asymptomatic or low-risk findings on stress tests are less likely to have appropriate indications for diagnostic catheterization 4.
- Patients with higher Canadian Cardiovascular Society grades of angina are more likely to have abnormal right-sided hemodynamic variables revealed by right heart catheterization 5.
- Patients with appropriate indications for coronary angiography are more likely to have obstructive coronary artery disease and undergo revascularization 6.
Timing of Exercise After Catheterization
The timing of exercise after catheterization is important, as: