Invasive hemodynamic assessments during exercise: normal patterns and clinical value

The diagnosis of heart failure (HF) is often challenging because symptoms or signs of HF commonly overlap with other conditions. It relies upon the demonstration of objective evidence of elevated filling pressures on the basis of biomarkers and/or hemodynamic indicators of volume overload. Echocardiography often provides valuable information including assessments of ventricular structure and function and valve disease but is less accurate to assess right- and left-filling pressures. Cardiac catheterization provides direct assessment for evidence of HF, but resting hemodynamics are often normal in milder or early stage of the disease. Invasive exercise hemodynamics provides the most robust and direct method to evaluate the causes for dyspnea or exercise intolerance and serves as the gold standard to confirm or refute the presence of HF in this population. In this chapter, we focus on the current understanding of the performance and proper interpretation of invasive exercise hemodynamics as they apply to patients being evaluated for HF or pulmonary hypertension.