Critical reappraisal of pulmonary artery catheterization and invasive hemodynamic assessment in acute heart failure

Abstract

Use of the pulmonary artery catheter (PAC) in the management of heart failure has declined precipitously despite guideline-supported indications, especially among patients hospitalized with acute heart failure (HF) syndromes. Here, the authors critically review the current role of the PAC and the management of patients with HF, and discuss the role of the PAC in the development of new therapies for HF. Pulmonary artery catheterization is a safe procedure when performed by experienced operators, and invasive hemodynamic evaluation with the PAC is recommended in select clinical settings. The PAC may have a unique role in identifying high-risk HF patients with persistent hemodynamic abnormalities during hospitalization. Early-phase trials of novel therapies to improve outcomes in patients with acute HF should include an assessment of hemodynamic effects utilizing the PAC. Once therapies that are effective in improving outcomes are available, the PAC might be a useful or necessary tool in the initiation and titration of such treatments and improved outcomes from PAC guided therapy may be demonstrated. Adequate training and experience are required to successfully use the PAC to minimize complications, ensure proper data collection and appropriate decision-making. Improved education and guidelines are required to ensure continued safe and appropriate contemporary use of the PAC.

Keywords::

• heart failure
• hemodynamic
• outcomes
• pulmonary artery catheterization
• therapeutic response

Financial & competing interests disclosure

J Butler serves as a consultant to Cardiomems, Inc. M Gheorghiade serves as a consultant for Medtronic, Inc., and has involvement with Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma AG, Cardiorentis Ltd, CorThera, Cytokinetics, CytoPherx, Inc., DebioPharm SA, Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Intersection Medical, Inc., Johnson & Johnson, Medtronic, Merck, Novartis Pharma AG, Ono Parmaceuticals USA, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, sanofi aventis, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT, Takeda Pharmaceuticals North America, Inc. and Trevena Therapeutics; and has received signficant (>US$10,000) support from Bayer Schering Pharma AG, DebioPharm SA, Medtronic, Novartis Pharma AG, Otsuka Pharmaceuticals, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT and Takeda Pharmaceuticals North America, Inc. The authors have no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

HF: Heart failure.