The clinical role of invasive hemodynamics in the evaluation and treatment of structural heart disease

ABSTRACT

Introduction

Recognition and evaluation of structural heart disease has become more common in clinical practice and will continue to grow as the population ages. With the growing availability of surgical and transcatheter interventional options, appropriate evaluation and patient selection for therapy is required. While echocardiography can frequently provide the required anatomic and hemodynamic information required to guide therapeutic decisions, there remains subsets of patients in which noninvasive testing yields inconclusive results prompting the need for invasive hemodynamics.

Areas Covered

This article reviews the indications and strengths of invasive hemodynamics in a variety of structural heart diseases. We describe the utilization and benefits of continuous hemodynamics during transcatheter interventions and review the prognostic information that can be gleaned from changes in hemodynamics after intervention.

Expert Opinion

The advancement of transcatheter therapies for structural heart disease has sparked a renewed interest in the utilization of invasive hemodynamics. Continued growth and accessibility of comprehensive hemodynamics for clinical practice will rely on clinicians to continually review, refine, and develop procedural techniques beyond the current training standards in order to further advance the field.

KEYWORDS:

• Invasive hemodynamics
• structural heart disease
• transcatheter interventions
• valve disease
• cardiac catheterization

Article highlights

• Invasive hemodynamic assessment is utilized when discrepancies are found on noninvasive imaging.

• Hemodynamic assessment in the catheterization laboratory allows inclusion of provocative measures to confidently elucidate the primary etiology of symptoms, severity of dynamic lesions, and optimal management strategy.

• Continuous hemodynamics is an important adjunct to transcatheter interventions and carries significant prognostic information.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.