Practical guidance for hemodynamic assessment by right heart catheterization in management of heart failure — Research

Navin Rajagopalan, MD, Barry A Borlaug, MD, Alison L Bailey, MD, Peter M Eckman, MD, Maya Guglin, MD PhD, Shelley Hall, MD, Maryl Montgomery, MD, Gautam Ramani, MD, Prateeti Khazanie, MD MPH · Expert review

Right heart catheterization recurs throughout this library as the decisive hemodynamic test in heart failure; this JACC Heart Failure expert review is the most practical, how-to entry of the set.

Rather than re-arguing why the procedure matters, the authors focus on doing it well — performing it, troubleshooting it, and interpreting the numbers across the full range of heart failure, from the stable outpatient to cardiogenic shock. The throughline is standardization: consistent technique and interpretation turn raw pressures into reliable decisions.

The practical takeaway is to integrate hemodynamic data systematically into heart-failure management rather than leaning on non-invasive estimates when precision matters. The resistance comes from general internists and non-interventional cardiologists less trained in the procedure or inclined toward non-invasive surrogates.

We rate the evidence moderate: a broad, multi-author expert review of best practices, with several authors disclosing industry ties (mitigated by the diversity of affiliations), but no new data. Its clinical significance is solid — practical, well-illustrated guidance that directly supports decisions in advanced heart failure and shock, where getting the hemodynamics right changes outcomes.