Cardiac catheterization in pulmonary hypertension: doing it right, with a catheter on the left

Elevated mean pulmonary artery pressure (mPAP) is the principal hemodynamic criterion for pulmonary hypertension (PH) (1-4)—a condition that is associated with increased clinical risk across a wide spectrum of diseases (4-7). Since increased mPAP may occur from a diverse number of risk factors and pathways (1,4,5,8), comprehensive clinical phenotyping with accurate cardiopulmonary hemodynamic assessment by cardiac catheterization is needed. By doing so, cardiac catheterization is important for classifying patients correctly to avoid misdiagnosis, delayed diagnosis, or the administration of inappropriate therapy (9). Integrating the hemodynamic and clinical profiles of patients at point-of-care is often challenging (10), however, and one common dilemma is establishing the contribution of left heart disease (LHD) to PH (11). Catheterizing the right heart and pulmonary arterial circulation is essential to allow for accurate diagnosis of PH, including PH-LHD (Group 2 PH), and for follow-up assessments.