Overview
Acute on chronic systolic heart failure (ACSH) is a clinical syndrome characterized by a sudden worsening of symptoms in patients with pre-existing systolic heart failure. This exacerbation often leads to increased hospitalizations and mortality.Diagnosis
Invasive hemodynamic testing, including right heart catheterization, is crucial for accurate diagnosis, phenotyping, and management of complex heart failure 1.
Hemodynamic assessment may include baseline and provocative testing (e.g., volume challenges, vasodilator challenges) to evaluate response to interventions and assess conditions like pulmonary hypertension 1.
Standardization of hemodynamic protocols is needed due to limited consensus on interpretation 1.Management
Invasive hemodynamic testing can guide management strategies, including vasodilator challenges to assess pulmonary hypertension reversibility in heart failure 1.
Provocative hemodynamic studies, such as volume challenges, can inform management decisions 1.Key Recommendations
Invasive hemodynamic testing, including right heart catheterization, is recommended for accurate diagnosis, phenotyping, and management of heart failure 1. (Evidence: Expert opinion)
Provocative hemodynamic studies, such as volume challenges and vasodilator challenges, should be considered to guide management decisions in heart failure 1. (Evidence: Expert opinion)
Standardization of invasive hemodynamic protocols and interpretation is necessary for consistent and effective patient care 1. (Evidence: Expert opinion)References
1 Belkin MN, Fudim M, Baratto C, Grinstein J, Hollis I, Ijioma N et al.. Standardization of Baseline and Provocative Invasive Hemodynamic Protocols for the Evaluation of Heart Failure and Pulmonary Hypertension: A Scientific Statement From the American Heart Association. Circulation. Heart failure 2026. link