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Table 2. Key Clinical Recommendations for Invasive
Hemodynamic Evaluations
Valvular heart disease
1. An invasive hemodynamic evaluation is recommended to resolve discrepancies
between clinical findings and noninvasive imaging data in patients with valvular
disease when surgical or catheter-based therapy is being considered.
2. Invasive hemodynamic studies of patients with valvular disease should be performed
with simultaneous measurement of multiple central cardiac chambers.
3. Invasive hemodynamic evaluations are beneficial for patients with valvular
regurgitation in certain scenarios, such as eccentric jets with difficult quantitation,
prosthetic valves with possible acoustic shadowing, and acute lesions in which color
flow Doppler might be limited.
Ventricular function
1. Although diastolic function is most comprehensively assessed by measuring
ventricular stiffness and relaxation, the commonly available methods of
catheterization with direct measurement of left and right-sided ventricular filling
pressures provide incremental diagnostic data on diastolic function.
2. In patients presenting with exercise intolerance, in which noninvasive and
resting invasive measurements are inconclusive, provocative testing in the cardiac
catheterization laboratory should be considered to determine the presence of a
cardiac etiolog y. Cycle ergometry exercise is the most physiologically relevant and
sensitive stressor and is preferred over other maneuvers such as saline loading or arm
exercise.
Pericardial disease
1. An invasive hemodynamic evaluation should be strongly considered for all
patients with suspected constrictive pericarditis due to the frequently complex
pathophysiolog y and the need for high diagnostic specificity when considering
surgery.
2. Invasive studies for constrictive pericarditis should entail examination of the dynamic
respiratory criteria.
3. An invasive hemodynamic study is typically not required for the diagnosis of cardiac
tamponade.
Pulmonary hypertension (PH) and the right ventricle
1. Invasive assessment of pulmonary hemodynamics is required for patients with
pulmonary hypertension who are being considered for vasodilator therapy and
cardiac transplantation.
2. Invasive assessment of pulmonary hemodynamics should be considered when there is
diagnostic uncertainty regarding pulmonary hypertension based on noninvasive data.
This assessment should establish the diagnosis according to WHO classification.
3. Invasive assessment of pulmonary hemodynamics should be performed to monitor
and assess the effectiveness of pulmonary hypertension therapies.
