Article Summary

1. Hemodynamic values can often be viewed too much as a single source of truth, without considering the imaging tests that accompany them. This can lead to misdiagnoses.
2. Clinicians should not view heart pressure values in isolation, but should look at them in relationship to each other to build a deeper understanding of a patient’s hemodynamic values and what they represent in terms of heart function.

Managing heart failure requires a comprehensive approach that integrates multiple sources of information, rather than relying on a single data set, says Paul Forfia, MD, co-director of Pulmonary Hypertension, Right Heart Failure & CTEPH Program at Temple University Hospital.

He cautions that hemodynamic values are too often viewed as a “table of truth,” and that considering these measurements at face value without proper context can be a dangerous mistake. “Hemodynamics is a global phenomenon, and it doesn’t require just doing a catheterization,” he says.

He recommends a five-step approach: comprehension, contextualization, correct acquisition, integration, and patient management.

Forfia shares tips and insights for assessing heart function in his presentation, “Under Pressure: Hemodynamic Profiles in Heart Failure.” 

Check Values Against Imaging

Understanding how the left and right sides of the heart work together and influence each other -- both directly and indirectly -- is one key to correctly interpreting patient data, he says. And cardiac imaging should always be used alongside pressure readings to ensure accurate diagnosis.

Too often, clinicians rely on hemodynamic values alone without comparing them to imaging tests, he says.

“The heart and the hemodynamics should match,” he explains. If they don’t, it could be a sign that measurements weren’t taken properly and heart pressure readings are inaccurate, leading to a potential misdiagnosis.

“You must look at your hemodynamics with knowledge of cardiac imaging to be fully powerful in your ability to manage patients and understand what’s going on,” he says. “Don’t throw out your clinical suspicion and the imaging just because someone gave you erroneous information.”

Consider Pressure Ratios

Similarly, Dr. Forfia adds that clinicians should not view heart pressure values in isolation, but should look at them in relationship to each other to build a deeper understanding of a patient’s hemodynamic values and what they represent in terms of heart function.  

Other points covered in the presentation include:

• Misconceptions about afterload and how to tell the difference between afterload and pressure
• Why it’s dangerous to assume that a small left ventricle in patients with pulmonary hypertension indicates that volume is needed for resuscitation
• How cardiac dysfunction in PAH does not often arise from weak right ventricular contractility, but from an imbalance caused by excessive afterload

Forfia also shares several examples and cases.