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4. Invasive assessment of pulmonary hemodynamics can be used to assess the risk of
right ventricular failure with advanced heart failure therapies.
5. In the appropriate setting, a properly performed and interpreted exercise
hemodynamic assessment can be a highly useful tool to elucidate a cause of dyspnea
or mechanism of PH.
Congenital heart disease
1. Cardiac catheterization should be performed for patients with shunts when there is
evidence of elevated pressures, chamber enlargement, or symptoms that are out of
proportion to the size of the congenital lesion, and prior to closure of shunts.
2. Cardiac catheterization should be performed to assess the hemodynamics of
congenital heart disease patients with known or suspected right ventricular failure,
especially in palliated single ventricle physiolog y.
3. Cardiac catheterization should be performed to determine the severity of
obstructions in series.
Cardiogenic shock and circulatory support devices
1. Invasive hemodynamic assessment, with measurement of ventricular filling pressures,
cardiac output, and systemic vascular resistance, is recommended for the diagnosis of
cardiogenic shock.
2. Continuous hemodynamic monitoring with a pulmonary artery catheter is
recommended for acute management of patients receiving therapy with mechanical
circulatory support.
3. Pulmonary artery catheterization is useful to guide withdrawal of mechanical
circulatory and pharmacologic support in patients with myocardial recovery from
cardiogenic shock.
4. In patients without recovery of myocardial and end-organ function, hemodynamic
monitoring is useful to assess candidacy for and transition to advanced heart
failure therapies, including durable mechanical circulatory support and heart
transplantation.
Hypertrophic Cardiomyopathy
1. For symptomatic patients being considered for septal reduction therapy, invasive
hemodynamic assessment with characterization of the dynamic LVOT obstruction
should be performed for those in which the noninvasive imaging studies are
inconclusive.
2. In the cardiac catheterization laboratory, transseptal assessment is preferred for
characterization of dynamic LVOT obstruction.
3. Dynamic LVOT obstruction at rest and with provocation should be examined.
Table 2. Key Clinical Recommendations for Invasive
Hemodynamic Evaluations (cont'd)
