For patients with stable, low-risk cases of pulmonary arterial hypertension (PAH), current noninvasive approaches to risk stratification and disease management may be useful and more feasible than invasive right heart catheterization (RHC), according to a new study published in Expert Review of Cardiovascular Therapy. The researchers discuss the most appropriate timing for RHC and when it could be appropriate to use noninvasive approaches instead.

“After diagnosis and initiation of therapy, many PAH centers continue to perform RHC at regular intervals to monitor for disease progression and alter management,” the authors wrote.

“In this review, we discuss the importance of risk stratification in PAH, the role of RHC in the treatment and stratification of these patients, compare non-invasive risk models to that of RHC parameters, and offer clinical scenarios where repeat RHC may be useful ‘as needed’ but not necessarily as a routine protocol.”


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RHC remains the standard for diagnosing PAH, evaluating mortality and morbidity risk, adjusting therapy levels, and monitoring disease progression. However, the introduction of more accurate noninvasive hemodynamic assessment methods such as the US Registry to Evaluate Early and Long-term PAH Disease Management Lite (REVEAL Lite) has been shown to offer reliable patient risk assessment and prognostic accuracy.

The authors caution that RHC remains crucial for diagnosing PAH and establishing initial therapy. However, in patients who have had RHC and have been assessed as stable and low-risk, they find that routine, invasive RHC is unlikely to offer additional benefits. In this patient group, the use of noninvasive assessment tools such as REVEAL Lite and employing RHC only “as needed” could be appropriate and reasonable.

Reference

Sharma D, Shah RJ, Sreenivasan J, et al. The role of serial right heart catheterization in risk stratification and management of pulmonary arterial hypertension. Expert Rev Cardiovasc Ther. Published online June 21, 2022. doi:10.1080/14779072.2022.2092095