Congestive heart failure cardiac catheterization

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Cardiac Catheterization

Coronary Angiography

Coronary angiography is perfomred in patients with heart failure in whom there is a suspicion of underlying atherosclerosis as the basis for the heart failure. Patients who are troponin or CK-MB positive, who have dynamic EKG changes or other signs and symptoms of an acute coronary syndrome who are revascularization candidates should undergo coronary angiography.

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 response to therapy

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 IIa

"1. Coronary arteriography is reasonable for patients presenting with heart failure who have chest pain that may or may not be of cardiac origin who have not had evaluation of their coronary anatomy and who have no contraindications to coronary revascularization. (Level of Evidence: C) "

"2. Coronary arteriography is reasonable for patients presenting with heart failure who have known or suspected coronary artery disease but who do not have angina unless the patient is not eligible for revascularization of any kind. (Level of Evidence: C) "