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Is right heart catheterisation still a fundamental part of the follow-up assessment of pulmonary arterial hypertension? The argument against

Right heart catheterisation (RHC) is arguably the most definitive and fundamental tool for diagnosing pulmonary hypertension, and is critical to distinguish between pre- and post-capillary pulmonary hypertension [1]. Without data obtained from a diagnostic RHC, pulmonary arterial hypertension (PAH) therapies should only be prescribed in the rarest of circumstances. It is the only test to provide accurate and precise information on the degree of elevation of the pulmonary vascular resistance (PVR), which is the primary pathophysiological process in PAH. For this reason, it has often acted as the primary end-point in phase II trials of pulmonary arterial vasodilator therapies for PAH. Noninvasive assessment of pulmonary arterial hypertension is adequate to provide a risk assessment in the majority of cases. Patients need to be managed in high-volume, expert centres with access to invasive haemodynamics for selected use in follow-up http://ow.ly/lXrq30koXZV