Right Heart Catheterization and Pulmonary Hemodynamics
Daniel Kretzschmar
Search for more papers by this authorP. Christian Schulze
Search for more papers by this authorDaniel Kretzschmar
Search for more papers by this authorP. Christian Schulze
Search for more papers by this authorGeorge D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorSummary
Right heart catheterization is a minimally invasive procedure and valuable for diagnosis and categorizing of various disease entities such as valvular heart defect, cardiogenic shock, chronic and acute heart failure, as well as patients with pulmonary hypertension. It provides hemodynamic measurement of intracardiac and pulmonary pressures. In addition to pure diagnosis, right heart catheterization is of upmost importance for therapy control in patients with low cardiac output syndrome, cardiogenic shock, and pulmonary hypertension.
This article describes indications, contraindications, and how to perform right heart catheterization.
References
- Lampert BC , Teuteberg JJ . Right ventricular failure after left ventricular assist devices . J Heart Lung Transpl. 2015 ; 34 ( 9 ): 1123 – 30 .
- Galie N , Humbert M , Vachiery JL , et al . 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT) . Eur Heart J . 2016 ; 37 ( 1 ): 67 – 119 .
- Krishnan A , Markham R , Savage M , et al . Right Heart Catheterisation: How To Do It . Heart Lung Circ. 2019 ; 28 ( 4 ): e71 – e8 .
- Hoeper MM , Lee SH , Voswinckel R , et al . Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers . J Am Coll Cardiol. 2006 ; 48 ( 12 ): 2546 – 52 .
- Callan P , Clark AL . Right heart catheterisation: indications and interpretation . Heart. 2016 ; 102 ( 2 ): 147 – 57 .
- Kovacs G , Avian A , Pienn M , et al . Reading pulmonary vascular pressure tracings. How to handle the problems of zero leveling and respiratory swings . Am J Respir. 2014 ; 190 ( 3 ): 252 – 7 .
- Rosenkranz S , Preston IR . Right heart catheterisation: best practice and pitfalls in pulmonary hypertension . Eur Respir Rev 2015 ; 24 ( 138 ): 642 – 52 .
- Kubiak GM , Ciarka A , Biniecka M , Ceranowicz P . Right Heart Catheterization-Background, Physiological Basics, and Clinical Implications . J Clin Med. 2019 ; 8 ( 9 ).
- Kaluzna-Oleksy M , Araszkiewicz A , Migaj J , et al . “From right to left”: The role of right heart catheterization in the diagnosis and management of left heart diseases . Adv Clin Exper Med Wroclaw Medical University . 2017 ; 26 ( 1 ): 135 – 41 .
- Pulmonary Artery Catheter Consensus conference: consensus statement . Critical Care Medicine . 1997 ; 25 ( 6 ): 910 – 25 .
- Ponikowski P , Voors AA , Anker SD , et al . ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC . Eur Heart J. 2016 ; 37 ( 27 ): 2129 – 200 .
- Hoeper MM , Bogaard HJ , Condliffe R , et al . Definitions and diagnosis of pulmonary hypertension . J Am Coll Cardiol. 2013 ; 62 ( 25 Suppl ): D42 – 50 .
- Fincke R , Hochman JS , Lowe AM , et al . Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry . J Am Coll Cardiol. 2004 ; 44 ( 2 ): 340 – 8 .
- O'Neill WW , Grines C , Schreiber T , et al . Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device . Am Heart J. 2018 ; 202 : 33 – 8 .
- Jacobs AK , Leopold JA , Bates E , et al . Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry . J Am Coll Cardiol. 2003 ; 41 ( 8 ): 1273 – 9 .
- Ghio S , Gavazzi A , Campana C , et al . Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure . J Am Coll Cardiol. 2001 ; 37 ( 1 ): 183 – 8 .
- Kirklin JK , Naftel DC , McGiffin DC , et al . Analysis of morbid events and risk factors for death after cardiac transplantation . J Am Coll Cardiol. 1988 ; 11 ( 5 ): 917 – 24 .
- Santamore WP , Gray LA , Jr . Left ventricular contributions to right ventricular systolic function during LVAD support . Annals Thorac Surg. 1996 ; 61 ( 1 ): 350 – 6 .
- Haddad F , Peterson T , Fuh E , et al . Characteristics and outcome after hospitalization for acute right heart failure in patients with pulmonary arterial hypertension . Circ Heart Fail. 2011 ; 4 ( 6 ): 692 – 9 .
- Moazami N , Pasque MK , Moon MR , et al . Mechanical support for isolated right ventricular failure in patients after cardiotomy . J Heart Lung Transpl. 2004 ; 23 ( 12 ): 1371 – 5 .
- Konstantinides SV , Meyer G . The 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism . Eur Heart J. 2019 ; 40 ( 42 ): 3453 – 5 .
- Grant AD , Smedira NG , Starling RC , Marwick TH . Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation . J Am Coll Cardiol. 2012 ; 60 ( 6 ): 521 – 8 .
- Kirklin JK , Naftel DC , Pagani FD , et al . Seventh INTERMACS annual report: 15,000 patients and counting . J Heart Lung Transpl. 2015 ; 34 ( 12 ): 1495 – 504 .
- Website. IRfMACSIO . http://www.intermacs.org/ . Accessed 8 February 2013 .
- Haddad F , Couture P , Tousignant C , Denault AY . The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment . Anesthesia and Analgesia. 2009 ; 108 ( 2 ): 407 – 21 .
- Thiele H VP , Schuler G. Cardiogenic Shock in E Eeckhout , PW Serruys , W Wijns , A Vahanian , M van Sambeek , R De Palma , eds. The PCR–EAPCI Textbook-Percutaneous Interventional Cardiovascular Medicine . Part III–Chapter 23. UBNS , Buffalo, New York .
- Korabathina R , Heffernan KS , Paruchuri V , et al . The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction . Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2012 ; 80 ( 4 ): 593 – 600 .
-
Simonneau G
,
Montani D
,
Celermajer DS
,
et al
.
Haemodynamic definitions and updated clinical classification of pulmonary hypertension
.
Eur Resp J.
2019
;
53
(
1
).
10.1183/13993003.01913-2018 Google Scholar
- Vachiery JL , Tedford RJ , Rosenkranz S , et al . Pulmonary hypertension due to left heart disease . Eur Resp J . 2019 ; 53 ( 1 ).
- Givertz MM , Hare JM , Loh E , et al . Effect of bolus milrinone on hemodynamic variables and pulmonary vascular resistance in patients with severe left ventricular dysfunction: a rapid test for reversibility of pulmonary hypertension . J Am Coll Cardiol. 1996 ; 28 ( 7 ): 1775 – 80 .
- Torres Macho J , Delgado Jimenez JF , Sanz Salvo J , Gonzalez Mansilla A , Sanchez Sanchez V , Gamez Diez S , et al . Effect of different pharmacologic agents to reverse severe pulmonary hypertension among end-stage heart failure patients . Transp Proc. 2009 ; 41 ( 6 ): 2477 – 9 .
- Costard-Jackle A , Fowler MB . Influence of preoperative pulmonary artery pressure on mortality after heart transplantation: testing of potential reversibility of pulmonary hypertension with nitroprusside is useful in defining a high risk group . J Am Coll Cardiol. 1992 ; 19 ( 1 ): 48 – 54 .
- Mehra MR , Kobashigawa J , Starling R , et al . Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates––2006 . J Heart Lung Transpl. 2006 ; 25 ( 9 ): 1024 – 42 .
- Kurzyna M , Araszkiewicz A , Blaszczak P , et al . Summary of recommendations for the haemodynamic and angiographic assessment of the pulmonary circulation. Joint statement of the Polish Cardiac Society's Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions . Kardiologia Polska. 2015 ; 73 ( 1 ): 63 – 8 .
- Rich S , Kaufmann E , Levy PS . The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension . New Engl J. Med. 1992 ; 327 ( 2 ): 76 – 81 .
- Sitbon O , Humbert M , Jais X , et al . Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension . Circulation. 2005 ; 111 ( 23 ): 3105 – 11 .
- Barst RJ , McGoon M , Torbicki A , et al . Diagnosis and differential assessment of pulmonary arterial hypertension . J Am Coll Cardiol. 2004 ; 43 ( 12 Suppl S ): 40S – 7S .
- Kearns MJ , Walley KR . Tamponade: Hemodynamic and Echocardiographic Diagnosis . Chest. 2018 ; 153 ( 5 ): 1266 – 75 .
- Hansen AT , Eskildsen P , Gotzsche H . Pressure curves from the right auricle and the right ventricle in chronic constrictive pericarditis . Circulation. 1951 ; 3 ( 6 ): 881 – 8 .
- Vaitkus PT , Kussmaul WG . Constrictive pericarditis versus restrictive cardiomyopathy: a reappraisal and update of diagnostic criteria . Am Heart J. 1991 ; 122 ( 5 ): 1431 – 41 .
-
Zile MR
,
Bennett TD
,
El Hajj S
,
et al
.
Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor: Relationship to Mortality in Patients With Chronic Heart Failure
.
Circ Heart Fail.
2017
;
10
(
1
).
10.1161/CIRCHEARTFAILURE.116.003594 Google Scholar
- Stevenson LW , Zile M , Bennett TD , et al . Chronic ambulatory intracardiac pressures and future heart failure events . Circ Heart Fail. 2010 ; 3 ( 5 ): 580 – 7 .
- Cowie MR , de Groote P , McKenzie S , et al . Cardio MP–MSI. Rationale and design of the CardioMEMS Post-Market Multinational Clinical Study: COAST . ESC Heart Failure . 2020 .
- Abraham WT , Adamson PB , Bourge RC , et al . Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial . The Lancet. 2011 ; 377 ( 9766 ): 658 – 66 .