Right Heart Catheterization: The Role of Hemodynamic Assessment in the Diagnosis and Management of Pulmonary Arterial Hypertension

Abstract

Right heart cardiac catheterization remains the gold standard for the diagnosis of pulmonary arterial hypertension and is an essential component to classify and characterize the type of pulmonary hypertension. Performing a diagnostic right heart catheterization for the assessment of pulmonary hypertension requires a detailed understanding of waveform physiology, cardiac output assessment, right ventricular afterload evaluation, vasoreactivity testing, and accurate left atrial pressure measurement. Furthermore, right heart catheterization can be used to unmask left heart disease by utilizing fluid challenge testing and exercise right heart catheterization. Additionally, the determination of pulmonary artery compliance , in conjunction with pulmonary vascular resistance, can help provide a more comprehensive assessment of pulmonary artery load and right ventricular afterload. Lastly, hemodynamic information obtained by right heart catheterization can be used as a risk assessment tool to guide management and predict mortality.