Congestive heart failure cardiac catheterization

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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
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Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Zand, M.D.[2] Lakshmi Gopalakrishnan, M.B.B.S. [3]

Overview

Coronary angiography is recommended in patients with heart failure, who have angina pectoris or an angina equivalent despite pharmacological therapy, in order to establish the diagnosis of CAD and its severity. Coronary angiography may also be considered in patients with HFrEF who have an intermediate to high pre-test probability of CAD and who are considered potentially suitable for coronary revascularization.

Cardiac Catheterization

Coronary Angiography

• Invasive coronary angiography is useful to rule out significant CAD in patients with cardiac dysfunction.
• It is recommended in patients with angina despite pharmacological therapy or symptomatic ventricular arrhythmias.
• In patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischaemia in noninvasive stress tests, invasive coronary angiography may be considered.

Hemodynamic Assessment

Right Heart Catheterization

Right heart catheterization can be useful to assess the following:

• Pulmonary capillary wedge pressure
• Pulmonary artery pressure to diagnose pulmonary hypertension and respond to therapy

  Right heart catheterization should be considered in patients where HF is thought to be due to constrictive pericarditis, restrictive cardiomyopathy,

congenital heart disease, and high output states.

Left Heart Catheterization

Left heart catheterization can be useful to assess the following:

• The aortic valve gradient, and diagnose aortic stenosis and track its severity
• The left ventricular end-diastolic pressure (LVEDP)
• Simultaneous assessment of the LVEDP and pulmonary capillary wedge pressure allows for the diagnosis and assessment of mitral stenosis.
• Dye can be injected to perform a left ventriculogram and assess for regional wall motion abnormalities, aortic insufficiency, and mitral insufficiency.

Class I

"Invasive coronary angiography is recommended in patients with angina despite medical therapy or symptomatic ventricular arrhythmias.(Level of Evidence: B) "

Class IIb

" Invasive coronary angiography may be considered in patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischemia in non-invasive stress tests.(Level of Evidence: B) "

Class I

" Right heart catheterization is recommended in patients with severe HF being evaluated for heart transplantation or mechanical circulatory support (Level of Evidence: C) "

Class IIa

" Right heart catheterization is reasonable in HF patients with suspicion of constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states.(Level of Evidence: C) "

Class IIb

" Right heart catheterization may be considered in selected patients with HFpEF to confirm the diagnosis..(Level of Evidence: C) "

The above table adopted from 2021 ESC Guideline