Diagnosis
Invasive Evaluation (see Table 8)
ÎÎInvasive hemodynamic monitoring with a pulmonary artery catheter
should be performed to guide therapy in patients who have respiratory
distress or clinical evidence of impaired perfusion in whom the
adequacy or excess of intracardiac filling pressures cannot be
determined from clinical assessment. (I-C)
ÎÎInvasive hemodynamic monitoring can be useful for carefully selected
patients with acute HF who have persistent symptoms despite empiric
adjustment of standard therapies, and (IIa-C):
• Whose fluid status, perfusion, or systemic or pulmonary vascular resistance is
uncertain;
• Whose systolic pressure remains low, or is associated with symptoms, despite
initial therapy;
• Whose renal function is worsening with therapy;
• Who require parenteral vasoactive agents; or
• Who may need consideration for mechanical circulatory support (MCS) or
transplantation.
ÎÎWhen ischemia may be contributing to HF, coronary arteriography is
reasonable for patients eligible for revascularization. (IIa-C)
ÎÎEndomyocardial biopsy can be useful in patients presenting with HF
when a specific diagnosis is suspected that would influence therapy.
(IIa-C)
ÎÎRoutine use of invasive hemodynamic monitoring is NOT
recommended in normotensive patients with acute decompensated
HF and congestion with symptomatic response to diuretics and
vasodilators. (III-B: No Benefit)
ÎÎEndomyocardial biopsy should NOT be performed in the routine
evaluation of patients with HF. (III-C: Harm)
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