Right heart catheterization in heart failure: indications, interpretation, and pitfalls

Right heart catheterization (RHC) plays a pivotal role across the spectrum of heart failure, from ambulatory patients to those in cardiogenic shock or under consideration for left ventricular assist device (LVAD) therapy and heart transplantation. Hemodynamic data are critical for early recognition of clinical deterioration, prognostication, and guiding treatment decisions. This state-of-the-art review provides a practical guide to hemodynamic assessment, troubleshooting, and interpretation of hemodynamic variables assessed with RHC for clinicians treating patients with heart failure in the acute setting, including acute heart failure and cardiogenic shock as well as chronic heart failure and advanced disease states that may warrant LVAD or heart transplantation. A special focus is set on contextualizing hemodynamic variables within the clinical presentation to avoid diagnostic misclassification. In addition, opportunities for future research, including novel parameters as well as forward-thinking non-invasive technologies to inform hemodynamics, are discussed.