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Findings on routine right heart catheterization in patients with suspected coronary artery disease
J T Barron1, N Ruggie, E Uretz
1Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, IL 60612.
Insights
Routine right heart catheterization in coronary angiography patients reveals significant hemodynamic abnormalities in 14.5%, influencing diagnosis and management, especially in severe angina.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Hemodynamics
Background:
- Routine right heart catheterization during coronary angiography is debated.
- Its utility in asymptomatic patients with coronary artery disease needs objective assessment.
Purpose of the Study:
- To evaluate the diagnostic yield of routine right heart catheterization in patients undergoing coronary angiography for angina.
- To determine if right heart catheterization influences patient management.
Main Methods:
- Retrospective analysis of hemodynamic data from 2,178 patients.
- Patients studied for angina without signs/symptoms of heart failure.
Main Results:
- 14.5% of patients had abnormal right-sided hemodynamic variables.
- Abnormalities included unsuspected mitral valve gradients, left-to-right shunts, pulmonary hypertension, elevated pulmonary capillary wedge pressure (PCWP), and subclinical left ventricular failure.
- Abnormality frequency increased with angina severity (Canadian Cardiovascular Society grade).
Conclusions:
- Right heart catheterization provides valuable diagnostic information in coronary angiography.
- Findings may significantly alter patient management strategies.
- Routine use is supported by the detection of significant, previously unsuspected conditions.
Abstract:
Whether catheterization of the right heart should be performed routinely in all patients undergoing coronary angiography for assessment of coronary artery disease is controversial. To objectively assess the utility of routine right heart catheterization, hemodynamic data from 2,178 patients studied for angina having no signs, symptoms, or history of congestive heart failure were analyzed retrospectively. The salient results are as follows: 0.9% patients had unsuspected mitral valve gradients greater than or equal to 5 mm Hg; 0.4% had occult left-to-right shunts; 1% had pulmonary hypertension (pulmonary artery systolic pressure greater than or equal to 40 mm Hg) not attributable to an elevated mean pulmonary capillary wedge pressure (PCWP); 4.8% had PCWP greater than or equal to 18 mm Hg; 6% had cardiac indexes less than or equal to 2.0 L/min/m2, suggesting subclinical left ventricular failure. Overall, 14.5% of patients had at least one abnormal right-sided hemodynamic variable revealed by right heart catheterization. The frequency of abnormalities increased with increasing Canadian Cardiovascular Society grade of angina. Ten percent of grade 1, 14% of grade 2, 15% of grade 3, and 19% of patient 4 patients had at least one abnormality (phi 2 test, p less than or equal to 0.005). It is concluded that the right heart catheterization adds an important dimension to the diagnosis and treatment of patients undergoing coronary angiography for assessment of coronary artery disease and might significantly influence subsequent patient management.