Congestive heart failure cardiac catheterization
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Zand, M.D.[2] Lakshmi Gopalakrishnan, M.B.B.S. [3] Edzel Lorraine Co, DMD, MD[4]
Overview
Overview
Coronary angiography is recommended in patients with heart failure, who have angina pectoris or an angina equivalent despite pharmacological therapy, in order to establish the diagnosis of CAD and its severity. Coronary angiography may also be considered in patients with HFrEF who have an intermediate to high pre-test probability of CAD and who are considered potentially suitable for coronary revascularization.
Cardiac Catheterization
- Invasive coronary angiography is useful to rule out significant CAD in patients with cardiac dysfunction.
- It is recommended in patients with angina despite pharmacological therapy or symptomatic ventricular arrhythmias.
- In patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischaemia in noninvasive stress tests, invasive coronary angiography may be considered.
Hemodynamic Assessment
Right Heart Catheterization
Right heart catheterization can be useful to assess the following:
- Pulmonary capillary wedge pressure
- Pulmonary artery pressure to diagnose pulmonary hypertension and respond to therapy
- Right heart catheterization should be considered in patients where HF is thought to be due to constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states.
- Computed tomography coronary angiography (CTCA) may be considered in patients with a low to intermediate pre-test probability ofCAD, or equivocal result of non-invasive stress tests in order to exclude the diagnosis of CAD.[1]
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: coronary arteriography, cardiac arteriography, cardiac angiogram, coronary angio, coronary artery angio, coronary cath, cardiac cath
General Principles
- Overview
- Historical perspective
- Contraindications
- Appropriate Use Criteria for Revascularization
- Complications
- Technique
- Film Quality
Coronary Anatomy and Projection Angles
Normal Coronary Anatomy
- Coronary arteries
- Left coronary artery | Left main coronary artery | Left anterior descending artery | Left circumflex artery | Ramus intermedius
- Right coronary artery
- Coronary artery dominance
Coronary Anatomic Variants
Projection Angles
Assessment of Perfusion
How to Assess Epicardial Coronary Blood Flow
- TIMI flow grade (TFG): TIMI flow grade 0 | TIMI flow grade 1 | TIMI flow grade 2 | TIMI flow grade 3
- TIMI frame count (TFC)
- Pulsatile flow
- Deceleration
How to Assess Myocardial Perfusion
- TIMI myocardial perfusion grade (TMPG): TIMI myocardial perfusion grade 0 | TIMI myocardial perfusion grade 0.5 | TIMI myocardial perfusion grade 1 | TIMI myocardial perfusion grade 2 | TIMI myocardial perfusion grade 3
Assessment of Lesion Morphology
Lesion Complexity
Thrombus Grades
- TIMI thrombus grade: TIMI thrombus grade 0 | TIMI thrombus grade 1 | TIMI thrombus grade 2 | TIMI thrombus grade 3 | TIMI thrombus grade 4 | TIMI thrombus grade 5 | TIMI thrombus grade 6
Lesion Morphology
- Quantitative angiography
- Definitions of Preprocedural Lesion Morphology
- Irregular lesion
- Disease extent
- Arterial foreshortening
- Infarct related artery (Culprit lesion)
- Restenosis
- Degenerated saphenous vein graft
- Collaterals
- Coronary artery ulceration
- Coronary artery aneurysm
- Coronary artery bifurcation
- Coronary artery trifurcation
- Technique
- Quantification of LV Function
- Quantification of Mitral Regurgitation
- Left Ventricular Ejection Fraction Assessment by Visual Estimation
Vein and Arterial Bypass Graft
Performing Diagnostic Catheterization
Risks stratification and benefits of PCI | Conscious Sedation | Preparation of the Patient for Diagnostic Catheterization | Technical Aspects of the Cardiac Catheterization Laboratory | Obtaining Venous and Arterial Access | Equipment Used in Diagnostic Cardiac Catheterizaiton | Hemodynamic Assessment in the Cardiac Catheterization Laboratory | Radiation Safety
Therapeutic Catheterization
Therapeutic procedures | Advances in catheter based physical treatments
PCI in Specific Lesion Types
Classification of the Lesion | The Calcified Lesion | The Ostial Lesion | The Angulated or Tortuous Lesion | The Bifurcation Lesion | The Long Lesion | The Bridge Lesion | Vasospasm | The Chronic Total Occlusion | Multivessel Disease | Distal Anastomotic Lesions | Left Main Intervention | The Thrombotic Lesion
PCI Complications
Vessel Perforation | Dissection | Distal Embolization | No-reflow | Abrupt Closure | Restenosis | Late Acquired Stent Malapposition | Loss of Side Branch | Multiple Complications | Coronary stent thrombosis | Slow flow | Pulsatile flow | Deceleration | Ectasia | Intimal flap | Staining | Coronary air embolism
2021 European Society of Cardiology (DO NOT EDIT) [2]
2021 European Society of Cardiology (DO NOT EDIT) [2]
| Class I |
| “Invasive coronary angiography is recommended in patients with angina despite medical therapy or symptomatic ventricular arrhythmias.(Level of Evidence: B) “ |
| Class IIb |
| ” Invasive coronary angiography may be considered in patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischemia in non-invasive stress tests.(Level of Evidence: B) “ |
| Class I |
| ” Right heart catheterization is recommended in patients with severe HF being evaluated for heart transplantation or mechanical circulatory support (Level of Evidence: C) “ |
| Class IIa |
| ” Right heart catheterization is reasonable in HF patients with suspicion of constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states.(Level of Evidence: C) “ |
| Class IIb |
| ” Right heart catheterization may be considered in selected patients with HFpEF to confirm the diagnosis..(Level of Evidence: C) “ |
| Class IIa |
| “Coronary CT angiography should be considered in patients with a low to intermediate pre-test probability of CAD or those with equivocal non-invasive stress tests in order to rule out coronary artery stenosis.(Level of Evidence: C) “ |
| Class IIa |
| “Endomyocardial biopsy should be considered in patients with rapidly progressive HF despite standard therapy when there is a probability of a specific diagnosis, which can be confirmed only in myocardial samples.(Level of Evidence: C) “ |
Genetic Evaluation and Testing 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [3]
| Class I |
| “1. In first-degree relatives of selected patients with genetic or inherited cardiomyopathies, genetic screening and counseling are recommended to detect cardiac disease and prompt consideration of treatments to decrease HF progression and sudden death. [4][5] (Level of Evidence: B-NR) ” |
| Class IIa |
| “1. In select patients with nonischemic cardiomyopathy, referral for genetic counseling and testing is reasonable to identify conditions that could guide treatment for patients and family members.[6][7] (Level of Evidence: B-NR) ” |
References
References
- ↑ Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ (January 2020). “2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes”. Eur Heart J. 41 (3): 407–477. doi:10.1093/eurheartj/ehz425. PMID 31504439.
- ↑ McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). “2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure”. Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check
|pmid=value (help). Vancouver style error: initials (help) - ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check
|pmid=value (help). - ↑ Marume K, Noguchi T, Tateishi E, Morita Y, Miura H, Nishimura K; et al. (2020). “Prognosis and Clinical Characteristics of Dilated Cardiomyopathy With Family History via Pedigree Analysis”. Circ J. 84 (8): 1284–1293. doi:10.1253/circj.CJ-19-1176. PMID 32624524 Check
|pmid=value (help). - ↑ Waddell-Smith KE, Donoghue T, Oates S, Graham A, Crawford J, Stiles MK; et al. (2016). “Inpatient detection of cardiac-inherited disease: the impact of improving family history taking”. Open Heart. 3 (1): e000329. doi:10.1136/openhrt-2015-000329. PMC 4762189. PMID 26925241.
- ↑ Pugh TJ, Kelly MA, Gowrisankar S, Hynes E, Seidman MA, Baxter SM; et al. (2014). “The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing”. Genet Med. 16 (8): 601–8. doi:10.1038/gim.2013.204. PMID 24503780.
- ↑ Haas J, Frese KS, Peil B, Kloos W, Keller A, Nietsch R; et al. (2015). “Atlas of the clinical genetics of human dilated cardiomyopathy”. Eur Heart J. 36 (18): 1123–35a. doi:10.1093/eurheartj/ehu301. PMID 25163546.
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