14
Diagnosis
Invasive Evaluation (see Table 10)
Î Invasive 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)
Î Invasive 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.
Î When ischemia may be contributing to HF, coronary arteriography is
reasonable for patients eligible for revascularization. (IIa-C)
ÎEndomyocardial biopsy can be useful in patients presenting with HF when
a specific diagnosis is suspected that would influence therapy. (IIa-C)
Î Routine 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)
Î Endomyocardial biopsy should NOT be performed in the routine
evaluation of patients with HF. (III-C: Harm)
Table 10. Recommendations for Invasive Evaluation
Recommendations COR LOE
Monitoring with a pulmonary artery catheter should be
performed in patients with respiratory distress or impaired
systemic perfusion when clinical assessment is inadequate
I C
Invasive hemodynamic monitoring can be useful for carefully
selected patients with acute HF with persistent symptoms and/or
when hemodynamics are uncertain
IIa C
When ischemia may be contributing to HF, coronary
arteriography is reasonable
IIa C
Endomyocardial biopsy can be useful in patients with HF when a
specific diagnosis is suspected that would influence therapy
IIa C
Routine use of invasive hemodynamic monitoring is NOT
recommended in normotensive patients with acute HF
III: No
Benefit
B
Endomyocardial biopsy should NOT be performed in the routine
evaluation of HF
III:
Harm
C
