The role of serial right heart catheterization in risk stratification and management of pulmonary arterial hypertension

ABSTRACT

Introduction

Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial blood pressure secondary to increased pulmonary vascular resistance.

Areas covered

Invasive hemodynamic assessment by heart catheterization (RHC) remains the gold standard to confirm the diagnosis, to determine the severity of right ventricular dysfunction and to test for pulmonary vasoreactivity. After diagnosis and initiation of therapy, many PAH centers continue to perform RHC at regular intervals to monitor for disease progression and alter management. We discuss the importance of risk stratification in PAH, the role of RHC in the evaluation and treatment of these patients and compare non-invasive risk assessment tools to that of RHC.

Expert opinion

RHC is useful for diagnosis of PAH, assessing the risk of mortality and morbidity, directing the escalation and de-escalation of therapy, and monitoring for disease progression. In the current era of improved non-invasive cardiac hemodynamic assessment, the role for routine follow-up serial RHC in patients with PAH needs to be reassessed in future studies. With the availability of non-invasive risk assessment tools such as REVEAL Lite 2, it may be reasonable to reconsider the role of annual or protocoled RHC, and instead, move on to an “as needed” and individual approach.

KEYWORDS:

• Pulmonary arterial hypertension
• right heart catheterization
• risk stratification tools

Article highlights

• Regular follow-up and assessment of pulmonary arterial hypertension is imperative to guide therapy.

• There are various tools available for assessment of risk in patients with pulmonary arterial hypertension. Each of these tools utilize different invasive and non-invasive techniques to stratify disease severity.

• In real-life practice, invasive techniques such as right heart catheterization (RHC) may not be regularly feasible, or indeed needed at regular intervals. Hence, we discuss appropriate timing for RHC and use of non-invasive tools when appropriate.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This paper was not funded.