What is the role of cardiac catheterization in the diagnosis of cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Although high-resolution echocardiography and magnetic resonance imaging are accurate methods to measure pulmonary pressure, [21] right heart catheterization is considered the most precise method for diagnosis and quantification of pulmonary hypertension. This procedure is indicated when echocardiography cannot assess the severity of a tricuspid regurgitant jet, thus excluding an assessment of pulmonary hypertension.

In patients with cor pulmonale, right heart catheterization reveals evidence of right ventricular (RV) dysfunction without left ventricular (LV) dysfunction. Hemodynamically, this typically presents as a mean pulmonary artery pressure (PAP) above 25 mmHg, which leads to elevated RV systolic pressures and central venous pressures (CVP). However, these findings are also seen in LV dysfunction. One method of differentiating left-sided from right-sided disease includes measuring the pulmonary capillary wedge pressure (PCWP), which is an estimation of left atrial pressure. Thus, RV dysfunction is also defined as having a PCWP below 15 mmHg, because failure of the LV would result in elevated LV end diastolic pressures and, subsequently, left atrial pressures. [6]

Right heart catheterization is occasionally important for differentiating cor pulmonale from occult left ventricular dysfunction, especially when the presentation is confusing. Another indication is for evaluation of the potential reversibility of pulmonary arterial hypertension with vasodilator therapy or when a left-sided heart catheterization is indicated.

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