Right heart catheterization for the diagnosis of pulmonary hypertension: controversies and practical issues

Diagnosing pulmonary hypertension hinges on a single number — the pressure in the pulmonary artery — and this review is about getting that number right.

Right heart catheterization remains the diagnostic gold standard for the condition, but the authors’ focus is on how easily it misleads. They walk through the technical controversies and interpretive pitfalls — zeroing, transducer position, reading pressures across the respiratory cycle — that can turn a definitive test into a wrong diagnosis in inexperienced hands.

The practical takeaway is that the procedure’s authority depends entirely on the skill behind it: standardized technique and trained interpretation are not optional refinements but the difference between a correct and an incorrect label for a serious disease. The resistance comes from clinicians inclined to lean on non-invasive estimates to avoid an invasive test they aren’t practiced in.

We rate the evidence moderate: an expert synthesis of practical know-how from authors at major pulmonary-hypertension centers, with no new data and no declared conflicts. Its clinical significance is moderate and focused — decisive for the specific population being worked up for pulmonary hypertension, where the catheterization reading drives treatment, but narrow beyond it.