Valvular heart disease – is there still room for invasive hemodynamic evaluation

    Authors

    Keywords

    Invasive hemodynamic evaluation, right-sided heart catheterization, valvular heart disease

    DOI

    https://doi.org/10.15836/ccar2021.310

    Full Text

    The development of echocardiographic methods and magnetic resonance for the evaluation of heart structure and function raises the question of the role of right-sided heart catheterization (RHC) or invasive hemodynamic evaluation (IHE) in valvular heart diseases. According to current guidelines, this method occupies a peripheral role and is reserved for situations where non-invasive testing is non-inclusive or discordant with clinical status ( 1 ). As pulmonary hypertension (PH) is one of the criteria for surgery in asymptomatic aortic stenosis and mitral regurgitation (MR), it is especially important to measure it accurately. However, non-invasive measurement of PH based on echocardiography has its limitations and the possibility of error and is particularly problematic in the presence of severe tricuspid regurgitation (TR) and reduced right ventricular (RV) function. A typical example where this is particularly important is persistent severe TR after mitral valve surgery leading to dilatation and dysfunction of the RV. Cardiac reoperation carries an increased risk, but it is considered in the absence of left-sided valve dysfunction, severe RV or left ventricular (LV) dysfunction and severe pulmonary vascular resistance/hypertension where RHC plays a key role ( 1 ). A particular problem for cardiac evaluation is multiple and mixed valvular heart disease, especially in the presence of some other heart pathology such as coronary heart disease, LV dysfunction or constriction ( 2 ). Exercise RHC is becoming increasingly popular in the diagnosis of heart failure with preserved systolic function, and now it is a question of its role in the diagnosis of valvular disease as well. The test has the potential to predict a worse outcome and thus for earlier surgery in asymptomatic patients e.g. with aortic stenosis or MR ( 3 ) . In conclusion, IHE is a useful and relatively harmless tool in the examination of valvular heart disease, but experience of cardiology teams is needed to get a true benefit of the method and to avoid misleading information. Gaining experience requires hard work perhaps even in cases where IHE is not fully indicated.

    Cardiologia Croatica
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    Valvular heart disease – is there still room for invasive hemodynamic evaluation

    Extended Abstract
    Issue9-10
    Published
    Pages310
    PDF via DOIhttps://doi.org/10.15836/ccar2021.310
    Invasive hemodynamic evaluation
    right-sided heart catheterization
    valvular heart disease

    Authors

    Matias Trbušić*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Nikola BuljORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Ozren VinterORCIDUniversity Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia
    Ivo Darko GabrićORCIDUniversity Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia
    Marko BobanORCIDUniversity Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia
    Diana Delić-BrkljačićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    Full Text

    The development of echocardiographic methods and magnetic resonance for the evaluation of heart structure and function raises the question of the role of right-sided heart catheterization (RHC) or invasive hemodynamic evaluation (IHE) in valvular heart diseases. According to current guidelines, this method occupies a peripheral role and is reserved for situations where non-invasive testing is non-inclusive or discordant with clinical status ( 1 ). As pulmonary hypertension (PH) is one of the criteria for surgery in asymptomatic aortic stenosis and mitral regurgitation (MR), it is especially important to measure it accurately. However, non-invasive measurement of PH based on echocardiography has its limitations and the possibility of error and is particularly problematic in the presence of severe tricuspid regurgitation (TR) and reduced right ventricular (RV) function. A typical example where this is particularly important is persistent severe TR after mitral valve surgery leading to dilatation and dysfunction of the RV. Cardiac reoperation carries an increased risk, but it is considered in the absence of left-sided valve dysfunction, severe RV or left ventricular (LV) dysfunction and severe pulmonary vascular resistance/hypertension where RHC plays a key role ( 1 ). A particular problem for cardiac evaluation is multiple and mixed valvular heart disease, especially in the presence of some other heart pathology such as coronary heart disease, LV dysfunction or constriction ( 2 ). Exercise RHC is becoming increasingly popular in the diagnosis of heart failure with preserved systolic function, and now it is a question of its role in the diagnosis of valvular disease as well. The test has the potential to predict a worse outcome and thus for earlier surgery in asymptomatic patients e.g. with aortic stenosis or MR ( 3 ) . In conclusion, IHE is a useful and relatively harmless tool in the examination of valvular heart disease, but experience of cardiology teams is needed to get a true benefit of the method and to avoid misleading information. Gaining experience requires hard work perhaps even in cases where IHE is not fully indicated.